Medical Staff Office Specialist Iv - Bellflower, United States - Kaiser Permanente

Kaiser Permanente

Verified Company

Bellflower, United States

3 weeks ago

Posted by:

Mark Lane

beBee recruiter

Description

Job Summary:

Essential Responsibilities:

Promotes learning in others by proactively providing and/or developing information, resources, advice, and expertise with coworkers and members; builds relationships with crossfunctional/external stakeholders and customers. Listens to, seeks, and addresses performance feedback; proactively provides actionable feedback to others and to managers. Pursues selfdevelopment; creates and executes plans to capitalize on strengths and develop weaknesses; leads by influencing others through technical explanations and examples and provides options and recommendations. Adopts new responsibilities; adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; champions change and helps others adapt to new tasks and processes. Facilitates team collaboration to support a business outcome.
Participates in training and regulatory awareness by: may be independently facilitating orientation and training to newly appointed physician leaders for effective oversight and management of their departments credentialing, proctoring, privileging and reappointment processes; developing moderately complex informational/educational documents (newsletters, memos) to communicate critical information regarding organizational programs and policies; independently developing and cultivating working relationships with key stakeholders, both internal and external, to ensure appropriate awareness of key issues and decisionmaking; and maintaining awareness of current internal policies and relevant external regulations and starting to provide moderately complex consultative expertise to internal parties.
Ensures quality assurance, improvement, and resolution by: independently obtaining and evaluating moderately complex practitioner sanctions, complaints, and adverse data to ensure compliance; participating in ongoing assessments of moderately complex governing documents (e.g., bylaws/rules and regulations/policies and procedures) to ensure continuous compliance; participating in surveys and audits of credentialing entities (e.g., CMOs, delegates and health plans for NCQA); independently facilitating efficient and costeffective due process that complies with internal fair hearing and appeals policies and external legal and regulatory requirements; identifying and escalating and preparing moderately complex adverse actions/issues (e.g., sanctions and complaints) to the credentialing committee taken against a practitioner/provider in accordance with applicable law and contractual requirements to the necessary parties; and independently conducting audits and reconciliations of data between different departments, monitoring of credentialing and contracting.
Conducts database management by: independently maintaining moderately complex structures and data within a computerized data base of physician data for use in the credentialling and appointment process, in alignment with department guidelines.
Enacts and analyzes data by: independently ensuring efficient file completion, conducting privileging analyses, and verifying privileging to the appropriate specialty/facility, based on data, with limited direction; and leveraging moderately complex tools and policies to support knowledge management, recordkeeping, and internal and external communication.

Minimum Qualifications:

Minimum one (1) year(s) of experience in a leadership role with or without direct reports.
Minimum two (2) years of experience with databases and spreadsheets.
Bachelors degree in Business Administration, Health Care Administration, Nursing, Public Health, or related field AND minimum three (3) years of experience in clinical credentialing, accreditation and regulation, licensing, health care, quality, or a directly related field OR minimum six (6) years of experience in in clinical credentialing, accreditation and regulation, licensing, or a directly related field.
Provider Credentialing Specialist Certificate within 36 months of hire

Additional Requirements:

Knowledge, Skills, and Abilities (KSAs): Negotiation; Compliance Management; Health Care Compliance; Health Care Data Analytics; Consulting; Managing Diverse Relationships; Delegation; Project Management; Health Care Quality Standards; Credentialling IT Application Software

PrimaryLocation :
California,Bellflower,Bellflower Medical Offices

HoursPerWeek : 40

Shift :
Day

Workdays :
Mon, Tue, Wed, Thu, Fri

WorkingHoursStart : 08:01 AM

WorkingHoursEnd : 05:01 PM

Job Schedule :
Full-time

Job Type :
Standard

Employee Status :
Regular

Employee Group/Union Affiliation :
NUE-SCAL-01|NUE|Non Union Employee

Job Level :
Individual Contributor

Job Category :
Quality & Safety

Department :
Bellflower MOB - Hosp Admin-Med Staff Office - 0801

Travel :
No