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Position Classification Description

Position Class Code / Title: A5021 / Credentialing Verification Rep
Recruitment Tier: Tier 1
FLSA: Non-Exempt
Grade: 09

This is a description of a Staff Position Classification. It is not an announcement of a position opening. To view descriptions of current openings, please go to UNMJobs and Search Postings to view positions that are currently accepting applications.

The following statements are intended to describe, in broad terms, the general functions and responsibility levels characteristic of positions assigned to this classification. They should not be viewed as an exhaustive list of the specific duties and prerequisites applicable to individual positions that have been so classified.

Summary

Coordinates, administers, and quality controls all aspects of the credentialing and privileging process for medical providers (physicians, professional staff, and network practitioners) practicing within the UNM Health System. Initiates and coordinates the reappointment process for existing providers; ensures accuracy and completeness of all documentation; serves as initial point of contact to medical providers and staff on day-to-day credentialing issues. Title reserved for UNM Health System Centralized Verification Office (CVO).

Duties and Responsibilities

  1. Reviews and screens initial medical staff credentialing applications for completeness, accuracy, and compliance with federal, state, local and University regulations, guidelines, policies, and standards.
  2. Performs external research and conducts verification of all applicant licensure, education and training, relevant past employment, and affiliations; assesses compliance with risk exposure criteria.
  3. Interprets federal, state, local, and government/insurance agency regulations and guidelines, as well as University, Medical Staff Bylaws, rules and regulations, policies and procedures; advises providers, management, and administrators on compliance issues as appropriate.
  4. Schedules, coordinates agenda for, and facilitates various committees charged with approving credentials and reappointments of medical providers within UNM Health System; provides support and follow up on matters arising from committee meetings.
  5. Interfaces with providers and health system entities, client departments, internal customers, and all related external health care agencies and customers on day-to-day credentialing and privileging issues as they arise.
  6. Monitors files to ensure completeness and accuracy; reviews all file documentation for compliance with quality standards, accreditation requirements, and all other relevant policies; prepares and provides information to internal and external customers as appropriate.
  7. Performs internet, agency, and/or internal research as appropriate to assess past high risk/liability activity with respect to medical staff; analyzes and prepares finding and submits to management.
  8. Provides a range of fiscal planning, administrative, and/or office managerial support to the CVO, as appropriate to the position.
  9. Performs miscellaneous job-related duties as assigned.

Minimum Job Requirements

  • High school diploma or GED; at least 5 years of experience directly related to the duties and responsibilities specified.
  • Completed degree(s) from an accredited institution that are above the minimum education requirement may be substituted for experience on a year for year basis.

Knowledge, Skills and Abilities Required

  • Ability to analyze, interpret and draw inferences from research findings, and prepare reports.
  • Ability to communicate effectively, both orally and in writing.
  • Information research skills.
  • Knowledge of provider credentialing/accreditation regulations, policies, guidelines, and standards.
  • Working knowledge of clinical and/or hospital operations and procedures.
  • Ability to use independent judgment and to manage and impart confidential information.
  • Database management skills.
  • Program planning and implementation skills.
  • Ability to make administrative/procedural decisions and judgments.
  • Knowledge of medical provider credentialing and accreditation principles, processes, procedures, and documentation.
  • Knowledge of computer spreadsheets and other related applications.

Working Conditions and Physical Effort

  • No or very limited physical effort required.
  • No or very limited exposure to physical risk.
  • Work is normally performed in a typical interior/office work environment.

The University of New Mexico provides all training required by OSHA to ensure employee safety.

Revised Date: 03/20/2017