Provider Credentialing & Onboarding Coordinator

About the role

The role coordinates the transition of all relevant provider credentials, licenses, degrees, privileges, and certifications upon signing of a new provider. It includes operational ownership of the centralized credentialing process, interfacing with new providers, gathering paperwork, coordinating documents, and submitting processes.

Responsibilities

• Facilitates the credentialing process for all incoming doctors and APPs
• Applies for state licensure, creates needed agreements, applies for drug dispensing licenses, completes multiple forms and packets
• Coordinates with outside facilities, training institutions, and device companies for privilege specific documentation including international institutions
• Interacts with references, facilitates interactions between the physician and onboarding team, and acts as the liaison between medical staff affairs/provider enrollment and incoming providers
• Sets up and coordinates practice and collaborative agreements, monthly meeting minutes for weekly calls, and scheduling
• Functions as the APP payroll representative and assists the Manager/Director with APP time off requests, meetings, other clerical functions as needed
• Coordinates the completion of reappointment packets with providers, including building complex reports from multiple data sources to validate volume requirements
• Tracks state licenses, board certifications, and needed training/educational certifications - collaborating with the physician for all initial and renewal requirements to ensure compliance and maintains up to date records for each provider
• Manages all provider evaluations - FPPE and OPPE (Quarterly and Yearly) - runs volume logs, coordinates multi-department signatures, obtains med staff approval, and maintains complete records while also distributing to needed partners
• Covers Health Partners Network (HPN) for payor enrollment to make sure all providers are enrolled with necessary payors
• Maintains working knowledge of JCAHO standards, NCQA standards, URAQ standards, the State Medical Board, and other regulatory agencies particularly with reference to accreditation and quality improvement
• Implements the appointment and reappointment process for all of the department faculty and APPS
• Manages and maintains an organized, systematic online database to record credentialing statistics and key information that is utilized in multipurpose functions across department and our key stakeholders
• Implements and maintains data, statistical and demographic, used to generate accurate medical staff profiles, quality improvement indicators, hospital-specific delineated privilege forms, etc. on an on-going basis
• Implements and maintains credentialing software
• Processes day-to-day WVUHS Insurance Provider Enrollment requests within the scope of contractual agreements
• Maintains updated individual staff profiles, reporting all changes to WVUHS Insurance Provider Enrollment as contracted
• Presents provider credentialing and onboarding status report in designated departmental meetings
• Immediately alerts department leadership of potential delays or barriers to providers’ onboarding date
• Ensures required documentation is received and saved to provider personnel files
• Completes and submits new hire documents based on individual department’s procedures
• Affords assistance in project work as identified by departmental needs
• Establishes and maintains engagement with new faculty members from date of signed offer letter through hire date and every two years for recredentialing at each site the provider has privileges

Qualifications

Minimum Qualifications:

• Associates Degree OR High School Diploma or Equivalent AND 2 years of healthcare or administrative experience
• One year of Experience with privileging/credentialing
• One year of Experience in a healthcare setting

PREFERRED QUALIFICATIONS:

• One year of Experience with privileging/credentialing
• One year of Experience in a healthcare setting

Skills and Abilities

• Basic computer knowledge and ability to operate standard office software
• Strong oral and written communication skills
• Ability to maintain high standards of confidentiality
• Strong organizational skills
• Ability to type at least 35 wpm preferred

Physical Requirements

• Prolonged periods of sitting
• Ability to lift 15-20 lbs
• Extended periods of computer and telephone usage

Working Environment

• Normal office environment
• May require Travel

Additional Job Description

• Scheduled Weekly Hours: 40
• Exempt/Non-Exempt Shift: United States of America (Non-Exempt)
• Cost Center: 671 SMG Corporate Admin
• Address: 3040 University Ave Morgantown West Virginia
• Equal Opportunity Employer