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Credentialing Coordinator

1 month ago

Upper Marlboro, United States University of Maryland Medical System Full time
Job DescriptionJob DescriptionCompany Description

Located in Largo in the heart of Prince George’s County, our new state-of-the-art regional medical center (UM Capital Region Medical Center) will provide improved access to primary and ambulatory care services, and serve as a tertiary care center for critically ill patients. In addition, our new space will allow us to expand our offerings as a community partner to help improve the health status of Prince George’s County residents.

Job Description

POSITION SUMMARY

Under the direct supervision of the Credentialing Supervisor, performs credentialing and re- credentialing in accordance with TJC, CMS and Medical Staff requirements for the purpose of Medical/AHP Staff membership and Privileges.  The Credentialing Coordinator manages practitioner files working cooperatively with practitioners, internal departments and contract groups to ensure the seamless and timely flow of credentials information in order to meet appointment ad reappointment deadlines.  Individual must demonstrate initiative, resourcefulness and problem-solving skills in executing functions to ensure the orderly flow of business.

Principal Duties:

1.   Coordinates UMCAP Medical/AHP Staff credentialing (initial and reappointment applications) - from receipt, to presentation to facilities for review/approval - verifying all background information, performing  gap  analysis,     performing  required  primary  source  verifications  of  information  on practitioner (verifying education, training, experience and competence), analyzing information obtained to ensure that membership and privilege requirements are met, within established timeframes.

2.   Partners with Medical Staff Office personnel at all UMCAP facilities to ensure an integrated, timely and consistent product, with the goal of ensuring regulatory and Bylaws requirements are met, and that practitioners do not have a gap in privileges.

3.   Collaborates with practitioners and/or contract and practice group contacts regarding status of applications, credentialing issues, pending expirations or expirations of required licensure and certifications, or questions and to ensure timely credentialing.

4.   Collects and, data, and prepares reports by monitoring data published by Maryland licensing boards, FSMB, OIG and NPDB and other applicable sources, screening for any adverse actions.

5.   Manages continuous credentialing process by collecting and analyzing documents and performing primary source verifications of medical malpractice insurance, licenses, prescriptive licenses, and other required certifications for membership and specific privileges.

6.   Maintains credential files in required format to meet requirements of Joint Commission, CMS and for legal presentations.

7.   Is responsible for organization of, and completion of, specific projects as required to meet new regulatory requirements and/or system changes.

8.   Maintains a working knowledge of Medical Staff Bylaws of client facilities.

9.   Maintains credentialing compliance with the accrediting and regulatory agencies (i.e., Joint Commission) while developing and maintaining a working knowledge of the regulations.

10. Is proactive regarding participation in available educational opportunities in the credentialing field.

11. Develops and maintains personal work processes that are cohesive with credentialing objectives and goal dates, and which can seamlessly be transferred to another coordinator if required.

Customer Service:

1.   Greets customers in courteous, friendly, respectful and professional manner at all times, including maintaining eye contact when appropriate.

2.   Follows communication protocols to both internal and external customers, including introducing him/herself with job title and experience, asking open ended questions, such as “How may I be of help to you?” using the customer’s name as soon as it is learned.

3.   Responds promptly and appropriately to customer questions/concerns/complaints and attempts immediate resolution.

4.   Keeps customer’s information confidential, including public places such as elevators or the cafeteria.

5.   Provides assistance and offers help immediately, including finding someone else to meet the request, if unable to do so him/herself. Introduce other staff to customers when a hand-off occurs and explain that the person will provide excellent service.

6.   Demonstrates commitment to excellent service recovery when a customer’s expectations have not been met.

Commitment to Co-Workers:

1.   Offers assistance to colleagues and other departments when needed.

2.   Takes responsibility for solving problems regardless of origin; completes assignments, and respects deadlines.

3.   Resolves conflict directly with colleagues and seeks assistance from others if the issue cannot be resolved. Refrains from criticism in public.

4.   Mindful and respectful of others’ time and schedules. Attends meetings on time and communicates any absences.

5.   Provides co-workers with a status report for continuity of workflow when planning to be out of the office, off the unit, or away from the department

Communication Etiquette:

1.   Respectful, courteous and professional in all forms of communication and follows facility’s service communication protocol in all interactions.

2.   Refrains from use of personal cell phone in patient care areas and keeps usage to a minimum at all other times while on duty.

3.   Does not text or use e-mail during meetings (except for exigent or emergency situations).

4.   Limits use of business cell phone during meetings (remain on vibrate and/or calls go to voicemail).

5.   Makes every effort to answer telephone calls within three rings, introducing him/herself, department and title (if appropriate).  Asks permission before placing the caller on hold or using the speakerphone.  If caller is transferred, gives the caller the extension number of the person he or she is being transferred to.  Offers further assistance to the caller upon completing the conversation.

6.   Maintains an appropriate voicemail message and when away from the office has an out-of-office email message that is brief, current, and includes name and department and offers the caller options if possible.

7.   Returns email and voicemail messages promptly but no later than within one business day (24 hours).

8.   Always mindful of voice and language in public.

Self Management:

1.   Reports to work appropriately groomed and in compliance with the Hospital’s dress code.  Wears identification badge at all times at chest level and facing outwards so identification is clearly visible.

2.   Complete all assignments within deadlines or negotiates alternative actions and time frames in order to achieve desired outcomes.

3.   Completes mandatory, annual education and competency requirements.

4.   Follows UMCAP safety, infection control and employee health standards.

5.   Demonstrates responsibility for personal growth, development and professional knowledge and competency.

6.   Adhere to all UMCAP and department policies and procedures, including Code of Conduct and professional behavior standards.  Does not exceed Hospital guidelines in reference to attendance, punctuality, and use of sick and unplanned absences.  Provides notification of absences, lateness and vacation requests according to department guidelines.  Respects length of time for lunch and break times.

7.   Reviews, signs, and adheres to UMCAP and/or departmental confidentiality statement.

Qualifications

POSITION REQUIREMENTS:

Licensure/Certification/Registration

Required:   Current Maryland in good standing as a

Education/Knowledge

Attained Level: Entry level

Preferred: Associates’ Degree in Healthcare Administration or related field.

Completed Course Work/Program:  High School Diploma

Applicable Experience

Experience (years):          Required:  1 year                           Preferred:  3 or more years

Experience (describe required & preferred):  One year of experience in a healthcare setting working with physicians, mid-level providers and office staff addressing coding and billing matters.

Technical/Clinical Skills

Microsoft Office Suite Skill Level

  • Word: Intermediate                                       
  • Excel: Intermediate
  • PowerPoint:  Basic                

Basic knowledge and working experience with Medical Terminology

Communication Skills & Abilities 

Select highest applicable level:  Exchange Information on Factual Matters

Problem Solving/Analytical Skills & Abilities:

Technical



Additional Information

All your information will be kept confidential according to EEO guidelines.