Credentialing Coordinator

Description

General Summary: A nonexempt position responsible for leading, coordinating, monitoring, and maintaining the credentialing and re-credentialing process.

Essential Job Responsibilities:

1. Leads, coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility.
2. Conducts thorough background investigation, research and primary source verification of all components of the application file.
3. Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.
4. Prepares credentials file for completion and presentation to Health System Entity Medical Staff Committees, ensuring file completion within time periods specified.
5. Processes requests for privileges, ensuring compliance with criteria outlined in clinical privilege descriptions.
6. Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and privileging issues as they arise.
7. Assists with managed care delegated credentialing audits; conducts internal file audits.
8. Utilizes credentialing database, optimizing efficiency, and performs query, report and document generation; submits and retrieves National Practitioner Database reports in accordance with Health Care Quality Improvement Act.
9. Monitors the initial, reappointment and expirables process for all medical staff, Allied Health Professional staff, Other Health Professional staff, and delegated providers, ensuring compliance with regulatory bodies (Joint Commission, NCQA, URAC, CMS, federal and state), as well as Medical Staff Bylaws, Rules and Regulations, policies and procedures, and delegated contracts.
10. Performs miscellaneous job-related duties as assigned.

Requirements

Education: High school diploma.

Experience: At least 4 years of experience with 2 years directly related to hospital medical staff or managed care credentialing.