Credentialing Coordinator - Remote

JOB TITLE: Credentialing Coordinator

GENERAL SUMMARY OF DUTIES: Initial applications and reappointment applications are processed in accordance with established policies, rules and regulations, bylaws, regulatory governmental standards. Communicates with applicants and clinical department administrators; prepares and distributes information and applications for professional staff appointment and clinical privileges; collects applications and all required documentation; enters information into the credentialing database; and performs primary source verifications. Participates in audits performed by regulatory and accrediting agencies, Department of Health, managed care organizations, and others; and functions as liaison, advisor and resource person for professional staff providers, department administrators, and other personnel.

SUPERVISION RECEIVED: Director of Credentialing Verification Organization

ESSENTIAL FUNCTIONS:

• Credentialing refers to the process of receiving and validating information on the professional qualifications of an individual who applies for appointment and reappointment in accordance with credentialing policies and procedures
• Review Physician and Allied Health initial and reappointment applications for completeness and accuracy and process for privileges to perform procedures at ASC by verifying education, training, experience, competency, license, certifications, National Practitioner Data Bank, etc. (as validated by queries from the approved primary source entities.
• Email out reappointment applications to providers 120 days prior to credentialing due date.
• Provide notification to the Facility Administrative Director, regional operations leader, and senior vice president of operations when appropriate, etc. when the credentialing process has been completed.
• Maintain, crosscheck, and upkeep of credentialing software database
• Attend department team meetings
• Provides initial and ongoing credentialing and credentialing database training for the facilities
• Other assigned duties.

EDUCATION/EXPERIENCE:

1. 1-3 years of experience with provider-level credentialing is highly desirable.
2. Knowledge of MD-Staff preferable.

KNOWLEDGE:

1. Knowledge of clinic policies and insurance procedures.
2. Knowledge of medical terminology and analyzing information.
3. Knowledge of Microsoft Office Products
4. Knowledge of state, federal and accreditation board regulations.

SKILLS:

1. Skill in gathering and reporting credentialing/certification information.
2. Skill in solving utilization problems.
3. Skill in written and verbal communication and customer relations.
4. Skill in working with Windows based software systems.

ABILITIES:

1. Ability to maintain strict confidentiality with demonstrated experience applying good judgment and discretion.
2. Ability to communicate effectively a must and work effectively with medical staff and external agencies.
3. Ability to identify, analyze and solve credentialing problems.
4. Ability to handle multiple projects and reach multiple deadlines.
5. Ability to serve as a resource person, resolve administrative problems, and exercise sound judgment in decision-making.
6. Excellent time management skills.
7. Exceptional ability to plan, organize, and implement a plan to completion.
8. Ability to deal courteously with internal and external customers.
9. Ability to prioritize duties and be self-motivated.
10. Ability to work with excel spreadsheets.
11. Ability to type 40-50 wpm.

PHYSICAL/MENTAL DEMANDS: Requires sitting and standing associated with a normal office environment.

ENVIRONMENTAL/WORKING CONDITIONS: Normal busy office environment with much telephone work. Occasional evening or weekend work.

Benefits: 

• Comprehensive health, dental, and vision insurance
• Health Savings Account with an employer contribution
• Life Insurance 
• PTO
• 401(k) retirement plan with a company match
• And more! 

Equal Employment Opportunity & Work Force Diversity 

Our organization is an equal opportunity employer and will not discriminate against any employee or applicant for employment based on race, color, creed, sex, religion, marital status, age, national origin or ancestry, physical or mental disability, medical condition, parental status, sexual orientation, veteran status, genetic testing results or any other consideration made unlawful by federal, state or local laws.  This practice relates to all personnel matters such as compensation, benefits, training, promotions, transfers, layoffs, etc.  Furthermore, our organization is committed to going beyond the legal requirements of equal employment opportunity to take positive actions which ensure diversity in the workplace and result in a multi-cultural organization.

This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.