Medical Credentialing Coordinator Jobs (NOW HIRING)

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ESSENTIAL FUNCTIONS

• Determines practitioner eligibility for membership/participation. Analyzes application and supporting documents for accuracy and completeness and informs the practitioner of the application status, including the need for any additional information or corrections. Obtains, researches, and evaluates information from primary sources to ensure compliance with accreditation and regulatory standards to validate the accuracy of applications for one or more decision making bodies, including a thorough background investigation and primary source verification of all components of the application file, such as applicant's education and training, licensure, work history, hospital affiliation history, malpractice claims history, board certification status, criminal background, evaluation of health status, and peer recommendations. Recognizes, investigates, and validates discrepancies and adverse information obtained during the application process to ensure review and approval bodies have information needed to make informed credentialing decisions. Processes requests for privileges when applicable, ensuring compliance with criteria outlined in clinical privilege descriptions.
• Monitors the initial and reappointment process for all Medical and Allied Health Professional staff as needed to ensure appointments are processed in the requested or required timeframes and meet regulatory requirements, including all required primary source verifications and other documentation. Monitors the status of completed files in departmental review and/or committee review until final approval to ensure compliance with regulatory standards. Monitors personal performance statistics related to accuracy and productivity and communicates with the managers when questions or concerns arise or when additional training is needed. 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 all policies and standards are met, including but not limited to, the Compliance office, Dean's office, Health office and Legal office. Communicates the status of applicant files directly to providers and various department representatives, clients, and/or affiliates and coordinates efforts to obtain necessary information and/or documentation related to the practitioner's appointment and to ensure deadlines are met. Communicates the status of expiring credentials, such as license, DEA, health reviews, PPD, infection control, specialty privilege requirements, etc., directly to providers and various department representatives and/or outside organizations, clients or affiliates and coordinates efforts to obtain necessary information and/or documentation to ensure deadlines are met. Serves as a resource for departments and clients pertaining to medical staff bylaw, policies, and procedures. Responds to inquiries from other healthcare organizations and interfaces with internal and external customers on day-to-day credentialing and privileging issues as they arise.
• In collaboration with management, reviews and assesses departmental functions and services to identify areas in need of improvement and implement changes as needed. Assists with various aspects of the credentialing expirables process, including but not limited to, annual health requirements, license, DEA, malpractice coverage, and board certification status. Represents the Medical Staff Services Department for various initiatives and/or committee meeting as needed. Serves as back up to other credentialing staff as needed. Serves as a Team Peer Interviewer as needed.
• Other duties as assigned.

MINIMUM EDUCATION & EXPERIENCE

• 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

KNOWLEDGE, SKILLS AND ABILITIES

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

LICENSES AND CERTIFICATIONS

• Certified Medical Professional Services Management (CPMSM) upon hire preferred
• Certified Provider Credentialing Specialist (CPCS) upon hire preferred

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