Credentialing Coordinator

Description

Job Summary: 

Administers credentialing process, works independently to coordinate, develop, monitor and maintain the credentialing process under the supervision of the Medical Staff Office 

Supervisory Responsibilities: N/A 

Essential Duties and Responsibilities: 

• Provides credentialing application packet to providers. 
• Provides re-credentialing application packet to providers when applicable. 
• Tracks the providers’ application to ensure a timely submission for credentialing/credentialing. 
• Responsible for all primary source verification. 
• Analyzes and resolves provider file issues. 
• Responds to Provider inquiries received by letter, phone, email, faxes and other internal departments. 
• Processes credentialing applications in accordance with accreditation standards, regulatory requirements, and policies and procedures. 
• Organizes the monthly Credentialing Committee. 
• Maintains provider files to ensure current licenses, insurances, privileges, and all other required certifications and develops rosters to track dates of expirations. 
• Responsible for the organization, maintenance, and accuracy of medical staff data on hard copy files and electronic employee credentialing files (scanning all documents into Share/ Provider Management folder). 
• Works closely with the Director of Managed Care Operations to ensure provider information and files are up to date for managed care contracts. 
• Provide weekly/monthly reports as needed. 

Qualifications

Knowledge, Skills and Abilities:

• Effective verbal and written communication.
• Good judgment, tact, and diplomacy.
• Ability to relate to and work with persons of all ages, social, and ethnic backgrounds.
• Must be organized and detail-oriented.
• Computer, problem solving and time management skills.
• Ability to show initiative, identifies critical issues, and recommends solutions to address concerns.
• Ability to speak comfortably in front of a group of professionals.
• Ability to maintain a high-degree of privacy.
• Analyze research, prioritize, meet deadlines, and maintain confidentiality.