Medical Staff Office Specialist Iii - Los Angeles, United States - Kaiser Permanente

Kaiser Permanente
Kaiser Permanente
Verified Company
Los Angeles, United States

4 weeks ago

Mark Lane

Posted by:

Mark Lane

beBee recruiter
Description

Job Summary:


Essential Responsibilities:


  • Pursues effective relationships with others by proactively providing resources, information, advice, and expertise with coworkers and members. Listens to, seeks, and addresses performance feedback; provides mentoring to team members. Pursues selfdevelopment; creates plans and takes action to capitalize on strengths and develop weaknesses; influences others through technical explanations and examples. Adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; helps others adapt to new tasks and processes. Supports and responds to the needs of others to support a business outcome.
  • Participates in training and regulatory awareness by: may be assisting in the facilitation of orientation and training to newly appointed physician leaders for effective oversight and management of their departments credentialing, proctoring, privileging and reappointment processes, with regular review from manager; developing standard and nonstandard informational/educational documents (newsletters, memos) to communicate critical information regarding organizational programs and policies; beginning to develop and cultivate 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 standard and nonstandard consultative expertise to internal parties.
  • Assists in quality assurance, improvement, and resolution by: obtaining and evaluating standard and nonstandard practitioner sanctions, complaints, and adverse data to ensure compliance, with regular review from manager; participating in ongoing assessments of standard and nonstandard 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); facilitating efficient and costeffective due process that complies with internal fair hearing and appeals policies and external legal and regulatory requirements, with regular review; identifying and escalating and preparing standard and nonstandard 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 conducting audits and reconciliations of data between different departments, monitoring of credentialing and contracting, with regular review.
  • Assists in governing databases by: maintaining structures and data within a computerized data base of physician data for use in the credentialling and appointment process, in alignment with department guidelines, with review.
  • 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 occasional review; and leveraging standard and nonstandard tools and policies to support knowledge management, recordkeeping, and internal and external communication.

Minimum Qualifications:


  • Minimum one (1) year(s) of experience with databases and spreadsheets.
  • Associates 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 four (4) 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): Health Care Compliance; Delegation; Project Management; Health Care Quality Standards; Credentialling IT Application Software

PrimaryLocation :
California,Los Angeles,4733 Sunset Annex

HoursPerWeek : 40


Shift :
Day


Workdays :
Mon, Tue, Wed, Thu, Fri

WorkingHoursStart : 08:00 AM

WorkingHoursEnd : 04:30 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 : 4733 Sunset Medical Offices - Hosp Admin-Med Staff Office - 0801


Travel :
No
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