Credentialing Coordinator II (Eastern United States resident)

About the Role

Plans, coordinates, and oversees procedures and processes of the Provider Credentialing Program in compliance with regulatory requirements. Ensures compliance with all credentialing and privileging requirements of applicable regulatory agencies. Conducts background investigations on physicians and other providers applying for affiliation including licensure, education and post-graduate clinical training, board certification, disciplinary actions and other professional sanctions, malpractice history, and peer assessment of current competence at time of appointment, reappointment, and cross credentialing.

Responsibilities

• Reviews and analyzes physician applications and credentialing documents including certificates of education, residency and fellowship training, board certification and eligibility, licensure, professional work history, liability insurance, and malpractice history.
• Assesses completeness of information and providers' qualifications relative to established standards.
• Reviews and analyzes primary source verification for licensure, certification, or registration required to practice a profession.
• Requests, maintains, and ensures competency data is present at appointment and re-appointment.
• Maintains tracking of all new providers' drug screening, background checks, child abuse clearance, fingerprinting, code of conduct, disruptive practitioner policies, current clinical competency data, and Health Service information for new providers.
• Maintains a working knowledge of applicable regulatory agencies.
• Immediately reports to manager any collected information which may be adverse to an applicant.
• Identifies and flags adverse information from application materials for the purpose of conducting special follow-up investigations in preparation for credentialing review.
• Maintains an understanding of third-party payor requirements.
• Prepares and screens, mails letters, tracks, and responds daily.
• Employs public relations skills in phone contacts with external sources for purposes of soliciting information essential to credentials investigations, including licensing agencies, university and hospital training program administrators, certification boards, liability insurance carriers, hospital officials, and credentials staff.
• Organizes and maintains physician files and information following confidentiality guidelines, performs varied clerical support functions.
• Internally audits and maintains physician files in accordance with established principles of legal documentation and confidentiality.
• Prepares all files monthly for Credentials Committee review and follows up on Credentials Committee decisions.
• Establishes and maintains excellent relationships and good communication channels with physicians, office staff, and practice administrators.
• Assists with special projects (e.g., physician education, JCAHO and Department of Health preparation, clinical competency data, life supports).
• Maintains a thorough understanding of the standards of JCAHO, Department of Health, Bylaws, Rules and Regulations of the Medical Staff, and other regulatory agencies as appropriate.
• Maintains provider database and manipulates database to extract information for ad hoc reports, surveys, and internal and external provider directory extracts.
• Adapts software as needed to facilitate efficient operation of the credentials department and continuous quality improvement.

Requirements

• High School Diploma or Equivalent (GED) (Required)
• Minimum of 4 years of related work experience (Required)

Preferred Experience

• Echo or Credential Stream experience

Work Environment

Work is typically performed in an office environment.

Benefits

• Healthcare benefits for full-time and part-time positions from day one, including vision, dental, and domestic partners.
• Atmosphere of collaboration, cooperation, and collegiality.

We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.