Credentialing Coordinator

About the role

The Credentialing Coordinator is responsible for the credentialing, re-credentialing, primary source verification, and ongoing monitoring of providers affiliated with Sharp HealthCare in accordance with applicable accreditation standards, regulatory requirements, policies, and bylaws. This position serves as a resource on credentialing processes and requirements for the Sharp hospitals, medical groups, and health plan. The Credentialing Coordinator is a steward of complete and accurate provider data in the applicable systems and the supporting processes to advance the quality of practitioners and patient safety at Sharp facilities.

Responsibilities

• Credentialing: Performs primary source verification of all required credentialing data elements for the initial and recredentialing processes in compliance with state and federal legislation and accreditation standards.
• Responsible for maintaining timely, complete, accurate credentialing files, in electronic format, for assigned provider files.
• Analyzes submitted applications for completeness and required documentation to identify missing data elements and time gaps.
• Conducts follow-up with applicant on identified adverse elements and investigates, as necessary, through to final resolution.
• Examines and evaluates verification results by cross-referencing to information reported on application and curriculum vitae.
• Analyzes materials for compliance with qualifications and criteria; investigates discrepancies and misstatements with applicant and other primary sources, as necessary, through to final resolution.
• Identifies key issues in core credentials data and recognizes and reports adverse information and unresolved questions to department Leadership and/or Credentialing Clients, as appropriate.
• Maintains accurate and current credentials in the credentialing database for all applicants; adds/updates all credentialing information upon receipt.
• Monitors and tracks application status through the credentials process, performing routine follow-up as outlined in department policy.
• Records clear notes of attempts to obtain verifications for transparency to Credentialing Clients and backups, when applicable, to determine status of application process.
• Responds to all internal and external customers via email or phone in a timely fashion to uphold a high level of customer service.
• Ensures a free flow of information and communication by actively listening and welcoming feedback to foster a safe environment.
• Process Improvement: Utilizes a continuous quality improvement approach to identify and initiate process improvements to maximize department efficiency, effectiveness, and productivity in daily work activities.
• Supports departmental operations through active engagement in huddles, assigned meetings, and ongoing performance improvement.
• Contributes to the planning, development and implementation of initiatives and automation.
• Regulatory Responsibilities: Maintains current knowledge of and continuous compliance with applicable accreditation standards, state and federal regulatory requirements, policies, and bylaws.
• Participates in credentialing training sessions offered by the department to stay abreast of changing standards and regulation.
• Participates in the development of and adherence to processes, policies, and procedures that support reliable departmental work product.

Requirements

• High School Diploma or Equivalent
• 3 years experience in hospital and/or healthcare credentialing

Preferred Qualifications

• Bachelor's Degree or equivalent work experience
• Certified Provider Credentialing Specialist (CPCS) - National Association Medical Staff Services
• Certified Professional Medical Services Management (CPMSM) - National Association Medical Staff Services

Knowledge, Skills, and Abilities

• Database management proficiency required; data entry skills required
• Detail-oriented with an understanding of data system organization
• Strong computational and data analytical skills
• Customer service oriented; able to interact with physician leadership, staff, and external organizations, including health plans, regulatory agencies, and licensing boards
• Strong communication skills (both written and verbal)
• Ability to exercise independent critical-thinking and problem-solving skills
• Demonstrates a high level of confidentiality and maintains data integrity
• Ability to independently manage workflow, set priorities, and develop goals and strategies to achieve them
• Aligns communication, ideas, processes, and resources to drive success

Shift: 7:30 AM – 4:00 PM, Monday–Friday; no weekends or on-call required.