Medical Services Professional

About the Company:

District Medical Group (DMG) is well known as a respected leader in the healthcare industry in the Phoenix area, with a reputation for outstanding leadership, innovation and dedication to the patients and communities we serve. DMG employs over 650 credentialed providers and more than 350 professional/administrative staff as one of the largest physician groups in the Valley.

What Does DMG Offer?

DMG continuously strives for and succeeds in providing a strong and positive work environment through employee appreciation, team collaboration, competitive compensation, mentoring, and great benefits including:

• A strong Healthcare benefits package inclusive of Medical, Dental and Vision– Employee eligibility effective DAY ONE
• A rich 401(k) with employer match, increasing annually up to 6%
• Flexible Spending Account plan
• Generous Paid Time Off plan (3 weeks year one)
• 10 paid holidays annually
• Paid Sick Time
• and more

About The Role:

The Medical Services Professional, under general supervision, coordinate initial credentialing and re-credentialing processes. Review applications received from physicians and allied health professionals for completeness and accuracy, obtaining verification of licensure, education/training, board certification, malpractice claims history, disciplinary actions, and sanctions for presentation to the Credentials Committee. Maintain credentialing database by updating information received during initial credentialing and re-credentialing processes. Act as a liaison between the provider and medical staff / credentialing offices for purposes of obtaining medical staff membership and privileges.

Schedule

This is a full-time position, Monday through Friday, 40 hours per week, in office.

What Your Primary Responsibilities Would Be:

• Process initial credentialing and re-credentialing applications for physicians and allied health providers.
• Review and analyze applications and credentialing documents for initial credentialing and re-credentialing, assessing completeness of information and qualifications to established standards.
• Identify and flag adverse information from application materials for the purpose of conducting special follow-up investigations in preparation for Credentials Committee review.
• Prepare, issue, track and follow-up on appropriate verification letters for adequate processing of each individual application, applying established procedural guidelines.
• Respond to and process requests to obtain membership and privileges for providers with hospitals, surgery centers, nursing homes, and other health care facilities.
• Enter data from provider applications into credentialing database, interpreting or adapting data to conform to defined data field uses.
• Enter contact and action notes into credentialing database to maintain accurate record of progress with processes.
• Assist Director and department for compliance and audit purposes.
• Internally audit, organize and maintain provider files and information in accordance with established principles of legal documentation, following confidentiality guidelines.
• Establish and maintain a professional working relationship with providers, their outside office staff, internal staff, and hospital staff.
• Proficient in the use of credentialing databases.
• Proficient in the use of NPI (National Practitioner Identification on-line access); IQRS (National Practitioner Data Bank on-line access); Certificates (American Board of Medical Specialties on-line access); AMA Physician Masterfile on-line access; AOA Physician Profile on-line access; State licensing agencies on-line access and Internet Explorer for other internet access.

The Successful Candidate Will Possess:

• High school diploma or equivalent required
• 3+ years in a hospital or managed care setting credentialing experience preferred.
• Certification by the National Association of Medical Staff Services in Certified Professional Medical Services Management (CPMSM) or Certified Professional Credentialing Specialist (CPCS) preferred.

• Demonstrate and maintain knowledge of all aspects of credentialing including legislative and regulatory compliance, internal processes, policies and procedures. Keep abreast of new and changing regulations and standards.
• Familiarity with The Joint Commission Medical Staff standards and the requirements for credentialing and privileging.
• Understanding/compliance of HIPAA laws and regulations.

• Computer proficiency (MS Office – Word, Excel and Outlook).

• Highly organized with excellent attention to detail and a demonstrated high regard for clerical accuracy.

• Excellent verbal and handwriting skills, including ability to effectively communicate with internal and external customers.

• Ability to work as a team player and independently. with willingness to assist other team members as needed.

• Must be able to work under pressure and meet deadlines, while maintaining a positive attitude and providing exemplary customer service.

DMG’s Employee Health Requirements:

As a condition of employment, District Medical Group (DMG) requires each employee to remain compliant with mandatory employee health (EH) standards. TB screening, Hep B, MMR, Varicella, and Influenza or approved declinations are required for this role.

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