Credentialing Coordinator

Responsibilities

• Participates in departmental activities to ensure quality in credentialing, privileging, and primary source verification processes.
• Serves as a resource and collaborates with other team members to enhance practitioner and patient safety.
• Determines practitioner eligibility for membership/participation.
• Analyzes application and supporting documents for accuracy and completeness, and informs practitioners of application status.
• Obtains, researches, and evaluates information from primary sources to ensure compliance with accreditation and regulatory standards.
• Determines and validates discrepancies and adverse information obtained during the application process.
• Processes requests for privileges when applicable, ensuring compliance with criteria outlined in clinical privilege descriptions.
• Maintains and monitors the initial and reappointment process for Medical and Allied Health Professional staff.
• Maintains and monitors the status of completed files in departmental review and/or committee review until final approval.
• Maintains personal performance statistics related to accuracy and productivity, and communicates with managers when necessary.
• Reviews performance measures and goals with auditors and management regularly.
• Collaborates and coordinates activities with the Credentialing Managers and staff.
• Collaborates with various departments and key stakeholders to ensure compliance with policies and standards.
• Communicates the status of applicant files directly to providers and various department representatives, clients, and/or affiliates.
• Communicates the status of expiring credentials directly to providers and various department representatives and/or external organizations.
• Serves as a resource for departments and clients regarding medical staff bylaws, policies, and procedures.
• Responds to inquiries from other healthcare organizations and interfaces with internal and external customers on credentialing and privileging issues.
• Assists with various aspects of the credentialing expirables process, including annual health requirements, licenses, DEA, malpractice coverage, and board certification status.
• Represents the Medical Staff Services Department for various initiatives and/or committee meetings as needed.
• Serves as backup to other credentialing staff as needed.
• Serves as a Team Peer Interviewer as needed.
• Performs other duties as assigned.

Requirements

• Associate's degree in business or healthcare related field and 2 years of medical administrative experience required, or equivalent combination of education and experience.
• 1 year of medical credentialing and/or payer enrollment experience preferred.

Qualifications

• Fluent English language skills (oral and written).
• Proficiency in MS Office (Word, Excel, PowerPoint), email, internet.
• Knowledge of and experience with Joint Commission, CMS, and NCQA Regulations related to medical staff services and Commercial Payers Credentialing.
• Knowledge of and experience with database applications.
• Exceptional interpersonal and communication skills.
• Ability to develop and maintain relationships with a variety of key stakeholders across the organization.

Skills

• Knowledge of and experience with Joint Commission, CMS, and NCQA Regulations related to medical staff services and Commercial Payers Credentialing.
• Knowledge of and experience with database applications.

Benefits

• Compliance with federal, state, or local laws.
• Commitment to diversity, equity, and inclusion.
• Non-discrimination in the administration of policies, admissions, employment, access, and recruitment of candidates.

Pay

• $23.06 - $32.29 per hour.

Schedule

• UR - Day (United States of America).