Health System Specialist (Credentialing and Privileging Specialist)

Full Job Description

The Health System Specialist (Credentialing and Privileging Specialist) is assigned to the Credentialing and Privileging Office, which is under the Chief of Staff and is responsible for providing administrative and technical direction and support to the credentialing and privileging (C&P) operations.

The incumbent is responsible for collecting relevant data and making informed decisions to ensure qualified health care professionals are providing appropriate care in appropriate settings.

Disclosure: This position is currently included in an OPM classification consistency review, which may result in an adjustment to the grade level.

To qualify for this position, applicants must meet all requirements by the closing date of this announcement. The Occupational Series 0671 includes an Individual Occupational Requirement (IOR).

Candidates may not hold a position in this series without meeting one of the IOR requirements established by OPM: Undergraduate or graduate education in a major field of study hospital administration, public health administration, or related fields such as business or public administration with course work in health care administration.

OR, Specialized experience in Missions, organizations, programs, and requirements of health care delivery systems; Regulations and standards of various regulatory and credentialing groups; and Government-wide, agency, and facility systems and requirements in various administrative areas such as budget, personnel, and procurement.

OR, Successful completion of an agency-sponsored on-the-job training program, it included a formal individualized training plan.

Such a training program must have been conducted in an operating health care system and included: Assignments providing a knowledge of basic health system administration philosophies, practices, and procedures, and basic government administrative policies and requirements; Practical assignments providing an opportunity to apply health system administration skills and principles (as the individual progresses, work assignments must be characteristic of the grade level to which he or she is assigned); and oversight by an experienced health system administrator with periodic evaluation of the individual's progress and appropriate adjustment of the training program.

In addition, you must also meet the specialized and/or experience as described below: GS-7: Specialized Experience: You must have one year of specialized experience equivalent to at least the next lower grade, GS-5, in the normal line of progression for the occupation in the organization.

Examples of specialized experience would typically include, but are not limited to: collecting relevant data and making informed decisions, developing short- and long-term goals necessary to accomplish the mission of a designated program, Receiving and reviewing correspondence and communications, Upon identification of a problem, researching reference materials, regulations, and standards to identify appropriate action necessary to correct the problem, utilizing databases and spreadsheets to track, monitor, and verify information.

NOTE: Experience must be fully documented on your resume and must include job title, duties, month and year start/end dates AND hours worked per week.

OR, Education: Applicants may substitute education for the required experience.

To qualify based on education for this grade level you must have successfully completed one (1) full year of graduate education.

Education at the graduate level must have been obtained in an accredited college or university and must demonstrate the knowledge, skills, and abilities necessary to do the work of this position.

NOTE: Transcripts must be submitted with application. Education cannot be credited without documentation. OR, Combination: Applicants may also combine education and experience to qualify at this level.

You must have an combination of specialized experience and successfully completed education beyond a bachelors degree to meet the total requirements.

The education portion must include graduate courses that demonstrate the knowledge, skills, and abilities necessary to do to the work of this position (i.e.

hospital administration, public health administration, or related fields such as course work in health care administration).

This education must have been obtained in an accredited college or university. NOTE: If using education combined with specialized experience to qualify, a copy of your transcript is required.

OR, Superior Academic Achievement (SAA): To qualify based on SAA you must have successfully completed all the requirements for a bachelor's degree in a curriculum that is qualifying (i.e.

hospital administration, public health administration, or related fields such as course work in health care administration) for the position to be filled and meet one of the following: Rank in the upper one-third of your class in the college, university or major subdivision; A grade-point average of "B" (a GPA of 2.95 or higher out of a possible 4.0) for all completed undergraduate courses, or those completed in the last two years of undergraduate study; A grade point average of "B+" (a GPA of 3.45 or higher out of a possible 4.0) for all courses in your major field of study, or those courses in your major completed in the last two years of undergraduate study; and Membership in a national honor society (other than freshman honor societies) recognized by the Association of College Honor Societies.

For a list of recognized honor societies please visit http://www.achsnatl.org/quick_link.asp GS-9: Specialized Experience: You must have one year of specialized experience equivalent to at least the next lower grade, GS-7, in the normal line of progression for the occupation in the organization.

Examples of specialized experience would typically include, but are not limited to: ensuring compliance with VHA policies, directives, and memos, assisting in goals necessary to accomplish the mission of the C&P Program, providing guidance and instruction to hospital staff in completing the required documentation, receiving and reviewing VetPro reports detecting problem areas requiring further investigation, advising and consulting on credentialing and clinical privileging for the organization.

OR, Education: Applicants may substitute education for the required experience.

To qualify based on education for this grade level you must have successfully completed a master's degree or equivalent degree, or successfully completed two (2) full years of progressively higher level graduate education leading to such a degree, or an LL.B or J.D., if related.

Such education must demonstrate the knowledge skills, and abilities necessary to do the work of this position.

OR, Combination: Applicants may also combine education and experience to qualify at this level.

You must have a combination of specialized experience, as described above, and successfully completed graduate level education beyond the first year to meet the total requirements.

The education portion must include graduate courses that demonstrate the knowledge, skills, and abilities necessary to do the work of this position.

Preferred Experience: Credentialing experience You will be rated on the following Competencies for this position: Communications, Compliance, Quality Assurance, and Technical Competence Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religions; spiritual; community; student; social).

Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment.

You will receive credit for all qualifying experience, including volunteer experience. Physical Requirements: This work is mostly sedentary.

Occasionally, light physical effort may be required, such as that involved with walking, stair climbing, and carrying of light office items For more information on these qualification standards, please visit the United States Office of Personnel Management's website at https://www.opm.gov/policy-data-oversight/classification-qualifications/general-schedule-qualification-standards/.

Major Duties:

Major duties include, but are not limited to: Performing as the subject matter expert (SME) to Licensed Independent Providers (LIPs) and Service Chiefs regarding routine and complex matters related to C&P.

Assisting the C&P Manager/Analyst in developing short- and long-term goals necessary to accomplish the mission of the C&P program.

Assisting the C&P Manager/Analyst in drafting local credentialing processes and Medical Staff Bylaws in compliance with all applicable regulations.

Receiving and reviewing VetPro reports detecting problem areas requiring further investigation.

Informing the C&P Manager/Analyst of trends identified, audit results and identified problems that may affect a provider's privilege status.

Providing guidance and instruction to hospital staff in completing the required documentation of establishing privileges for LIPs.

Assuring application packages and other documents meet technical requirements per specialty of provider and assures application folder and database account (VetPro or other internal databases and spreadsheets) meet technical requirements.

Serving as technical advisor to the Executive Committee of the Medical Staff (ECMS) and if applicable the Credentials Committee.

Developing and providing routine and special reports as requested by the C&P Manager/Analyst. Establishing and maintains a variety of files and records pertaining to the C&P process.

Promotion Potential: The selectee may be promoted to the full performance level without further competition when all regulatory, qualification, and performance requirements are met.

Selection at a lower grade level does not guarantee promotion to the full performance level. Work Schedule: Monday-Friday, 8:00am-4:30am Virtual: This is not a virtual position.

Position Description Title/PD#: Health System Specialist (Credentialing and Privileging Specialist)/PD99876A Relocation/Recruitment Incentives: Not Authorized Critical Skills Incentive (CSI): Not approved Permanent Change of Station (PCS): Not Authorized As a condition of employment for accepting this position, you will be required to serve a 1-year probationary period during which we will evaluate your fitness and whether your continued employment advances the public interest.

In determining if your employment advances the public interest, we may consider: your performance and conduct; the needs and interests of the agency; whether your continued employment would advance organizational goals of the agency or the Government; and whether your continued employment would advance the efficiency of the Federal service Upon completion of your probationary period your employment will be terminated unless you receive certification, in writing, that your continued employment advances the public interest.