Medical Staff Credentialing Coordinator

Description

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Position is not remote

The Medical Staff Credentialing Coordinator is responsible for providing support services to the Organization’s centralized Medical Staff Services Department (MSSD) and those facilities designated for centralized credentialing.

Primary responsibilities include, but are not limited to, coordinating, and assisting in the practitioner initial appointment and reappointment application process, collection and coordination of all data required for the timely and accurate completion of the initial appointment and / or reappointment application process for all practitioners.

The Medical Staff Credentialing Coordinator supports the Medical Staff Services department’s efforts to develop and implement streamlined processes within the organization MSSD.

Essential Functions :

• Maintains credentialing database to ensure the integrity of the practitioner data is current and accurate.
• Enters initial appointment and reappointment application data into credentialing database.
• Monitor and track progress of applications, as well as status of primary source verifications / documents to ensure timely and accurate completion of practitioner applications, and forwards files to the Manager / Director when completed.
• Evaluates processes and solves problems identified throughout the application process.
• Monitors the initial, reappointment, and expirables process for all credentialed practitioners ensuring compliance with regulatory bodies, as well as Medical Staff Bylaws, Rules and Regulations, policies and procedures, and delegated contracts.
• Ensure the organization maintains regular cooperation and compliance with all regulatory, accrediting, and membership-based organizations.
• Reviews and evaluates practitioner applications and supporting documentation..
• Ensures that all Medical Staff applicants go thorough background investigation, research, and primary source verification of all components of the file.
• Performs queries; submits and retrieves National Practitioner Databank reports in accordance with Health Care Quality Improvement Act.
• Identifies any issues that may require additional investigation and evaluation, validates discrepancies, and ensures appropriate follow up.
• Prepares credentials file for completion and presentation to the Medial Staff Committees, ensuring file completion within time periods specified.
• Ensures that the facilities processes requests for privileges, ensuring compliance with criteria outlined in clinical privilege descriptions.
• Responds to inquiries from other healthcare organizations regarding credentialing and privileging issues as they arise.
• Performs other duties as assigned.

Requirements

Education / Experience :

• Associate degree or equivalent work experience.
• A minimum of three (3) years experience in a hospital medical staff services department or managed care credentialing environment is required.
• Certified Provider Credentialing Specialist (CPCS) or Certified Professional in Medical Services Management (CPMSM) preferred

Skills / Abilities :

• Demonstrates strong computer skills to navigate MS office products and electronic compliance software solutions.
• Knowledge and understanding of CMS, The Joint Commission and State Department of Health and Hospitals regulations regarding Medical Staff.
• Good written and oral communication skills.
• Demonstrates personal traits of a high level of integrity, team orientation, professionalism, and trustworthiness.
• Places a high value on ethical standards and treating others with dignity and respect.

Work Environment :

Subject to many interruptions. Occasional pressure due to multiple calls and inquiries. This position can be high paced and stressful;

must be able to cope mentally and physically to atmosphere. Work requires spending approximately 90% or more of the time inside a building that offers protection from weather conditions but not necessarily from temperature changes.