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
Within the UNM Health System Centralized Verification Office (CVO), evaluates, analyzes, and coordinates all aspects of the credentialing and recredentialing process for practitioners practicing within the UNM Health System clinical entities. Provides integral support to healthcare operations by enabling timely onboarding of healthcare providers. Leads departmental activities to ensure quality in conducting, maintaining, and communicating practitioner credentialing, privileging, and primary source verifications. Manages day-to-day file reviews and supports colleagues with complex files.
Duties and Responsibilities
Reviews, screens, and audits initial and reappointment credentialing applications for completeness, accuracy, and compliance with federal, state, local and University regulations, guidelines, policies, and standards; provides assistance and support to others as needed.
Conducts primary source verification, collects and validates documents to ensure accuracy of all credentialing elements; assesses completeness of information and qualifications relative to credentialing standards and UNM Health System criteria.
Identifies, analyzes and resolves extraordinary information, discrepancies, time gaps and other idiosyncrasies that could adversely impact ability to credential and enroll practitioners; discovers and conveys problems to CVO Credentialing Manager and entity Medical Staff Affairs for sound decision making in accordance with Medical Staff Bylaws, credentialing policies and procedures, federal, state, local and government/insurance agency regulations.
Audits and 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.
Participates in credentialing audits consistent with managed care delegated credentialing contracts; assists with reporting requirements.
Assists CVO Manager in review of CVO operating policy and procedures, maintains knowledge of entity medical staff bylaws, rules and regulations, policies and procedures, and managed care credentialing policies; recommends and assists with implementing changes, revisions and enhancements as appropriate to current operating environment.
Assists CVO Manager in providing on-site consultations across UNM with regards to credentialing practices and services; prepares and conducts credentialing orientations and provides updates as appropriate on new policies and procedures.
Enters, updates, and maintains data from provider applications into credentialing database, focusing on accuracy and interpreting or adapting data to conform to defined data field uses, and in accordance with internal policies and procedures.
Prepares, issues, tracks, and follows-up on appropriate verifications for efficient, high-volume processing of individual applications in accordance with applicable credentialing standards, established procedural guidelines, and strict timelines.
Participates in the development and implementation of process improvements for the system-wide credentialing process; prepares reports and scoring required by regulatory and accrediting agencies, policies and standards.
Communicates clearly with providers, their liaisons, entity Medical Staff Affairs, medical staff leadership. and administration as needed to provide timely responses regarding on day-to-day credentialing and privileging issues as they arise.
Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest developments to enhance understanding of various regulations and legislation of the health care industry.
Performs miscellaneous job-related duties as assigned.
Minimum Job Requirements
Successful completion of at least 60 college-level credit hours; at least 3 years of experience directly related to the duties and responsibilities specified.
Certification/Licensure NAMSS Certification as a Certified Professional Medical Services Manager (CPMSM) or must be eligible and obtain NAMSS CPMSM or CPCS certification within two years from date of hire.
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 communicate effectively both orally and in writing.
Customer service skills.
Ability to respond to emails timely and effectively.
Information research skills.
Knowledge of medical provider credentialing and accreditation principles, policies, processes, procedures, and documentation.
Working knowledge of clinical and/or hospital operations and procedures.
Ability to use independent judgment and to manage and impart confidential information.
Ability to maintain confidentiality and discretion in all communications on behalf of credentialing applicants and/or applications.
Ability to make administrative/procedural decisions and judgments.
Demonstrated advanced working knowledge of Microsoft Word and Excel.
Database management skills.
Skill in establishing priorities with independent coordination of day-to-day aspects.
Ability to foster effective working relationships within a team environment.
Conditions of Employment
Must possess a valid National Association Medical Staff Services (NAMSS) Certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentialing Specialist (CPCS); within two years from the date of hire.
Must maintain certification status.
Employees who provide services or work in patient care or clinical areas are required to be in compliance with the University's influenza vaccination requirement.
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.
