Health System Specialist (Credentialing & Privileging Spec)

Full Job Description

The incumbent is assigned to the Medical Staff Office, which is under the Chief of Staff at a VA Medical Center (VAMC) and is responsible for providing administrative and technical direction and support to the credentialing and privileging (C&P) operations.

The C&P Specialist is aligned to and supervised by the C&P Manager. To qualify for this position, applicants must meet all requirements by the closing date of this announcement.

You may qualify based on your experience as described below: Individual Occupational Requirements: Health System Administration Series, 0671: Undergraduate and Graduate Education: Major 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: Progressively responsible analytical or administrative, or clinical management or supervisory experience in the health care field.

This work may have been performed in an operating health care facility or a higher organizational echelon with advisory or directional authority over such facilities.

Work must have involved a close working relationship with facility managers and analysis and/or coordination of administrative, clinical, or other service activities, and provided knowledge of the following: 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 Special Provision for Inservice Placement: Successful completion of an agency-sponsored on-the-job training program may be substituted for qualifying experience, provided 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.

AND Specialized Experience GS-09: Applicants must have one (1) full year of specialized experience related to this position.

This experience must have been equivalent to at least the GS-07 grade level in the Federal Service.

Examples of specialized experience would typically include but are not limited to: Experience with analytical techniques investigating the efficiency and effectiveness of work operations.

Experience with administrative functions such as preparing and coordinating budget, staff, and projects. Experience providing recommendations for improvement in planning and management.

Skill in effective communication and negotiation. Experience researching laws, regulations and policies.

-OR-Master's or equivalent graduate degree-OR-2 full years of progressively higher -level graduate education leading to such a degree-OR-LL.B.

or J.D., if related-OR-Combination of Experience & Education: Applicants may also combine education and experience to qualify at this level.

You must have an appropriate combination of specialized experience and education.

To calculate, first identify the percentage of required education you have earned (when substituting, you cannot use the first 60 semester hours that you earned).

Then identify the percentage of required experience you possess. Add the two percentages. The total percentage must equal at least 100 percent to qualify at the GS-XX.

For example, an applicant who has 9 semester hours of graduate level education (i.e. 50% of graduate education required) and 6 months of creditable specialized experience (i.e.

50% of the required experience) would equal 100% of the required experience for the position A transcript must be submitted with your application if you are basing all or part of your qualifications on education.

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. Major Duties:

The duties and responsibilities include but are not limited to the following: Ensure suspense(s) are met in the time sensitive actions for privileges modification, biennial renewals, temporary limitations or suspensions, and any other time-limited privileging action.

Provide guidance and instruction to hospital staff in completing the required documentation of establishing privileges for licensed independent providers.

Provide ongoing review of regulatory requirements, Joint Commission Standards, changing laws and legal precedents to review current hospital regulations for making necessary changes within compliance.

Assure application folder and database account, VetPro or other internal databases and spreadsheets, meet technical requirements.

Monitor providers' data relative to state licensure, Drug Enforcement Organization (DEA) license, National Practitioner Data Bank (NPDB), Continuous Query (CQ) enrollments and renewals, Federation of State Medical Boards (FSMB), documentation of professional education, specialty medical training, certifications, adverse licensure or privileging actions, initial and renewal of privileges which may affect the status of privileges granted for medical practice.

Ensure accurate provider data is entered into and maintained in the computer program, such as VetPro.

Conduct final appointment into the VetPro database, after thoroughly researching, analyzing and validating all data, information, documents and signature authorities.

Assure data entry is complete and accurate to meet hospital policy and regulation, and The Joint Commission standards.

Inform manager on audit results and identified problems that may affect a provider's privilege status.

Refer current issues, trends, problem areas as well as recommended program revisions to Credentials and Privileging functions through the Manager/Analyst.

Research material, such as regulations and standards, to identify appropriate action necessary to correct the problem.

Review reports from credentialing software, such as VetPro, detecting problem areas requiring further investigation.

Provide informed decisions to ensure qualified health care professionals are providing appropriate care in appropriate settings.

Assist in identifying the resources necessary for accomplishing the mission and function of the credentials and privileging program.

Coordinate credentialing meetings which includes preparing agendas, notifying attendees, and providing documents for committee action.

Provide administrative support to a credentialing and privileging office.

Work Schedule: MONDAY through FRIDAY, 8:00AM to 4:30PM Position Description Title/PD#: Health System Specialist (Credentialing & Privileging Spec)~/99876A Physical Requirements: The 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.