Job Description

The Credentialing Specialist is responsible for maintaining the quality and reliability of the collection and verification of practitioner applicants professional qualifications. The Credentialing Specialist completes initial and ongoing quality audits while providing constructive feedback. Additionally, the Credentialing Specialist is responsible for data analysis, action plan development and assisting in the establishment and achievement of business objectives in affiliation with all Keck Medicine of USC entities and clients.

Essential Duties:

• Responsible for the audit of the Credentialing processes. Audits 100% of credentialing and re-credentialing files and data entered into the Credentialing Database, of all Keck Medicine of USC entities and clients processed by the USC Office of Integrated Credentialing.
• Conduct audits to verify compliance with established business processes and that an effective system of internal controls is in place. Audit and monitor data, systems, and processes to ensure compliance with relevant accreditation and regulatory standards and internal policies and procedures.
• Assist in development and implementation of corrective action plans.
• Conduct mock audits and to assist in development of corrective action plans to address any identified issues
• Assist in the development of processes and procedures to verify credentialing elements such as education, training, board certification, work history, licensure, and certifications.
• Ensure business processes are performing within desired standards. Evaluates that applications are properly verified and uploaded into the online credentialing database system.
• Works with Manager or Director of the entity to prepare credentialing and re-credentialing files for accreditation surveys, mock surveys, pre-delegation and delegation surveys.
• Returns audited files showing any oversight to the relevant credentialing coordinator who originally prepared the file, for the purposes of data correction, education and coaching.
• Provides audit reports and conducts analysis including trend identification, and opportunities for improvement in order to provide individual and department level performance improvement plans. Ensure data is accurate, consistent, complete, and valid according to established standards.
• Demonstrates leadership skills and sets an example of personal performance which encourages excellence in integrity.
• Communicates clearly and concisely using strong decision making skills.
• Adheres to established guidelines as defined by Entity/Department policies.
• Maintains current knowledge of computers, systems, and applications that impact operations of Credentialing.
• Keeps current with TJC, DNV, NCQA, CMS, AAAHC and other applicable state and federal Credentialing regulations and guidelines.
• Maintains current knowledge of Credentialing and auditing industry trends.
• Independently make decisions regarding whether information meets OIC, TJC, NCQA, DNV, Title 22, and CMS and relevant bylaws/Credentialing Plan requirements related to content, completeness and timeliness.
• Ensures maximum confidentiality, accuracy, security, and appropriate access of all data and records, and provides maximum protection from discoverability of all information.
• Performs other duties as assigned.

Required Qualifications:

• Req Bachelor's degree in related field

• Combination of experience/education may substitute for minimum education requirement

• Req 3-5 years 3-5 years experience as a credentialing professional

• Req Ability to plan own schedule, set priorities and work independently in accomplishing work assignments on time.
• Req Knowledge of Joint Commission, DNV, AAHC, and NCQA standards, Title 22, and CMS regulations pertaining to the organized medical staff, required
• Req Knowledge of medical staff principles, practices, quality assessment, performance improvement functions, and legal concepts related to the organized medical staff, required
• Req Effective analytical and critical thinking verbal and written communication skills.
• Req Proficiency in use of MD-Staff, related applications/internal systems to collect information necessary to complete principal accountabilities.

Preferred Qualifications:

• Pref Certified Professional in Medical Services Management (NAMSS) Valid CPMSM or CPCS certification by the National Association of Medical Staff Services strongly preferred

Required Licenses/Certifications:

Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)

The annual base salary range for this position is $81,120.00 - $133,010.00. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidates work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.

About University of Southern California (USC)

USC is the leading private research university in Los Angeles—a global center for arts, technology and international business. With more than 47,500 students, we are located primarily in Los Angeles but also in various US and global satellite locations. As the largest private employer in Los Angeles, responsible for $8 billion annually in economic activity in the region, we offer the opportunity to work in a dynamic and diverse environment, in careers that span a broad spectrum of talents and skills across a variety of academic and professional schools and administrative units. As a USC employee and member of the Trojan Family—the faculty, staff, students, and alumni who make USC a great place to work—you will enjoy excellent benefits, including a variety of well-being programs designed to help individuals achieve work-life balance.

Connections working at University of Southern California (USC)

Job Tags

Full time, Work experience placement, Local area,

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