Credentialing Program/Compliance Coordinator

JOB POSTING CREDENTIALING PROGRAM/COMPLIANCE COORDINATOR Job Code: 7224 Non Represented, Non-exempt

GENERAL SUMMARY: Ensures an effective credentialing and recredentialing program meets or exceeds standards and those of Credentialing Committee, JCAHO and NCQA, maintains compliance with all national, state and local statutes related to peer review. Responsible for ensuring ongoing compliance for CPMG HR. Maintains knowledge of policies and procedures and performs in accordance with applicable regulatory requirements, external laws and accreditation standards as they relate to CPMG HR.

POSITION REQUIREMENTS: Bachelor’s degree in business administration, human resources or related area. Equivalent experience will be considered. Additionally, two years of hospital or multi- specialty group credentialing experience to include substantial experience in policy development and/or managing compliance processes. Knowledge of JCAHO and/or NCQA credentialing standards. Must be skilled in personal computer applications such as word processing, spreadsheets, and data base management.

ESSENTIAL DUTIES: Assists in the development of policies, procedures and processes to ensure timely and efficient credentialing/recredentialing for KFHP/Affiliated Allied Health Professionals, and CPMG Affiliated/Practitioners in: hospitals, medical offices, surgical clinics, and health plan. Develops and maintains policies and processes to assure full compliance with all federal, state and local statutes, and with Credentialing Committee, JCAHO and NCQA standards. Coordinates the Credentialing Program and assists with assignments among credentialing staff; identifies problems and/or opportunities. Improves credentialing program; devises and implements efficient strategies for gathering, storing, analyzing, reporting and tracking provider information. Leads annual external credentialing audits of contracted affiliated hospitals and entities assuring compliance to Credentialing Committee and NCQA credentials standards. Assigns and distributes workload regarding audits and monitors audit processes. Monitors corrective action plans pertinent to assuring full compliance to credentialing standards. Participates in community credentialing activities/user boards, committees and represents Organizations’ audits with external agencies to ensure appropriate credentialing practices. Program Integration: Integrates credentialing processes with credentialing Committee, adjusts review process, conducts audits/reporting with community medical affiliates. Interfaces with quality programs and maintains up to date quality files. Assists in the development of routine and special system reports, provides ad hoc reporting, updates data for integrity and accuracy. Assists in the development of automated personal computer system applications where necessary. Gathers, stores, analyzes, reports and tracks practitioner credentialing information and quality file information. Edits data collection for complete record of credentialing information.

For Essential Responsibilities In addition to defined technical requirements, accountable for consistently demonstrating service behaviors and principles defined by the Kaiser Permanente Service Quality Credo, the KP Mission as well as specific departmental/organizational initiatives. Also accountable for consistently demonstrating the knowledge, skills, abilities, and behaviors necessary to provide superior and culturally sensitive service to each other, to our members, and to purchasers, contracted providers and vendors.

Functional and Environmental Factors available upon request.

Revised December 2007