Credentialing Coordinator

POSITION SUMMARY:

Under the direction of the Director of the Credentialing Verification Office, with daily activities supervised by the Credentialing Manager, this position performs all duties for processing initial and recredentialing medical provider applications per NCQA, The Joint Commission, DNV, CMS, State and Federal regulations, and Medical Staff By-Laws.

Credentialing Coordinators ensure that medical staff members maintain current credentials and licenses to work legally in their field or specialty. These specialists work with medical staff members or applicants to advise them of the required steps to gain/maintain their credentials

This is a remote working position. A laptop and required equipment will be furnished. High speed internet service is the responsibility of the applicant.

KEY RESPONSIBILITIES:

Responsibilities include (but are not limited to):

• Acts independently to process medical credentialing applications and the supporting documentation according to compliance guidelines provided.
  • Reviews the provider applications for completion and identifies the missing items and/or concerns.
  • Request appropriate follow up information from the Medical Staff Office(s) or other sources as needed.
  • Reviews the primary source verifications for accuracy and notifications of reported items.
  • Coordinates the credentialing process for assigned providers.
• Ensure files are maintained according to and all applicable governing agencies and internal quality and security policies, to include electronic document management. Needs to maintain an organized electronic filing system.
• Collects and maintains all pertinent information from the provider. Communicates consistently with the Medical Staff Office or provider’s office contact in a timely and effective manner to follow up to obtain required documents in alignment with regulated processing guidelines.
• Verifies all credentialing elements, including but not limited to, education, training, board certification, work history, licensure and certifications, malpractice coverage; through a variety of primary sources as deemed appropriate per NCQA, DNV, TJC & CMS standards.
• Enters data accurately and completely in the credentialing software.
• Analyzes provider files for completeness, accuracy, consistency, gaps in work history, relevant references, etc. Identifies issues and initiates further data collection as needed. Communicates completion of the file to the appropriate Medical Staff Office or provider’s office.
• Maintains thorough understanding of NCQA, TJC, DNV, CMS and state(s) regulatory credentialing standards.
• Responsible for the quality and integrity of provider files and meets processing quality and productivity standards.
• Performs routine file audits.
• Adheres to strict confidentiality requirements.
• Other duties as assigned.