Nashville General Hospital Careers

Description

Credentialing and Privileging Specialist, Full-Time job, Physician Services

Nashville General Hospital is hiring a Medical Staff Credentialing Specialist for Physician Services as a full time Day Shift job in Nashville, Tennessee.

• Processes temporary privileges according to the Medical Staff Credentialing Policy, maintains detailed records about appointment timeframes and demographics
• Works closely with service line leaders to understand needs and schedules
• Works closely and professionally with the CVO to aid in the timely appointment, reappointment and addition of privilege processes
• Reviews practitioner’s privilege requests to verify that they meet established criteria, are within their scope of practice, and are presented accurately and in a prompt fashion to the Credentials Committee, Medical Executive Committee and the Board as directed 

• Leads payer enrollment for new practice locations and entities in a professional and timely manner
• Completes and processes payer enrollment applications for Providers for Medicare and Medicaid and submits required information for delegated credentialing for the remaining insurance carriers, aligned with PHO policies and procedures
• Completes timely follow up on all applications 
• Prepares and presents material for routine audits for delegated credentialing
• Maintains providers profiles and NPI’s, CAQH and internal spreadsheets
• Monitor and maintain current documents (licenses, malpractice insurance)
• Maintain confidentiality of all providers information

• Ability to represent the Medical Staff Services and Nashville General Hospital in a positive and professional manner, understands and engages in the NGH philosophy of “managing up” across all levels of the organization
• Assists NGH leaders by coordinating medical staff support functions for the Medical Staff organization as outlined in the entity Medical Staff Bylaws and policies
• Supports all providers and external customers with finding solutions to concerns, and acts as a liaison between the providers and other hospital departments (IT, security, HR, administration) 
• Coordinates and completes special projects promptly, appropriately prioritizes all tasks so that deadlines are met with continued focus on quality, and keeps all stakeholders apprised of any critical or major situations
• Maintains schedule for reviewing policies and procedures, and assists in policy revision process
• Assists in facilitating educational programs following ACCME accreditation guidelines
• Coordinates and maintains accurate on-call schedules for Emergency Department coverage, and a creates on-call schedules per contractual obligations and department rules and regulations
• Conducts physician onboarding to include processing paperwork needed for IT access, paperwork needed for badge, and physician orientation for all practitioners, residents and students as needed
• Conducts ID verification per the Medical Staff Credentialing Policy for all new Medical Staff members and privileged providers
• Coordinates all Medical Staff meetings, including General Medical Staff meetings, and responsible for scheduling room, catering requests, preparing attendance sheets, and minutes 
• Participates in cross-training of new employees as needed to support department initiatives

• Associate Degree in Business or Healthcare or equivalent combined professional training and experience
• 7 years of experience in Medical Staff Services as a Credentialing Specialist or Medical Staff Coordinator
• In-depth knowledge of credentialing principles, processes, and standards, including NCQA, Joint Commission, and CMS requirements.
• Strong analytical skills with the ability to interpret complex regulations and accreditation standards.
• Expert level proficiency with Excel, Outlook and Word
• Ability to work well in a team environmen
• Ability to triage priorities and handle conflict in a reasonable fashion with demonstrated time management skills
• Project management skills needed to take lead role in new initiatives
• Excellent communication skills, both written and verbal
• Dependable with positive, service-oriented attitude
• Proven ability to multitask with excellent diligence
• NAMSS Certification or Dual Certification (CPCS or CPMSM) or actively pursuing certification with success within one year from hire date required

• Bachelor’s degree in business or healthcare administration
• 10 years of experience in Medical Staff Services payer enrollment and credentialing
• Demonstrated, expert level experience with Microsoft Office
• Dual Certification through NAMSS
• Preferred at least 8 years recent payer enrollment and delegated credentialing
• experience working with a PHO

Hours:  Monday – Friday 8:00 am – 4:30 pm, with flexibility for early morning and evening meetings.  May require travel to local offsite locations

About Nashville General Hospital

Nashville General Hospital (NGH) is Nashville’s original community- based hospital. Joint Commission accredited, NGH readily accommodates a wide range of needs from emergency services and acute care to ancillary and ambulatory services. NGH continues to maintain its strong commitment to the healthcare needs of Nashville and Davidson County underserved, while also providing care to all segments of the community.

Our benefits include:

• Medical, Dental, and Vision Insurance within first 31 days of employment
• Programs to reduce share of deductible and total out-of-pocket expenses
• Metro Health Incentive Program - Access to high quality healthcare without incurring out-of-pocket expenses
• Short and Long-Term Disability - up to 60% of eligible weekly pay
• Life Insurance - Metro provides you with basic life and AD&D coverage equal to $50,000 ($32,500 if you are age 65 or older), at no cost to you.
• 401K Retirement Plan - eligible up to IRS max limits and includes company contribution
• Shift and Weekend Differential Pay Offered on Nights and Weekends
• Tuition Reimbursement for employee and dependents
• 12 paid holidays - any holiday worked is another holiday banked
• Flexible Spending Accounts
• Free Parking for all employees

Join our team at Nashville General Hospital. Apply today!

We are an E-Verify employer.

For more information, please click on the following links:
E-Verify Participation Poster: English | Spanish
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