Credentialing Coordinator

2 days ago

Jackson, United States Franciscan Missionaries of Our Lady Health System Full time
Job Description

The Credentialing Coordinator oversees the credentialing program and is responsible for credentialing compliance with Medical Staff Bylaws, Rules and Regulations, policies and procedures and federal and state regulations. The Credentialing Coordinator is responsible for analysis of credentials files, privilege requests, and payor enrollment. Relies on education, some experience and judgment to accomplish job. Ability to process and manage applications. Works under general supervision. Creativity and some latitude is expected to complete responsibilities.

Responsibilities

Coordination
  • Coordinates and provides appropriate guidance to the medical staff/allied health professional during initial credentialing, privilege delineation, and reappointment activities in accordance with the medical staff policies, bylaws, and rules and regulations to ensure qualified practitioner care. - Activities associated with this function include but are not limited to: management of applications, verification of credentials, monitoring various industry databases for evidence of potentially adverse information for medical staff leadership review, red flagging potentially adverse information for medical staff leadership review, identification of areas where practitioners may not meet privileging or membership criteria. - Assures that all documentation reflects that required activities are undertaken by individual evaluators and meeting members and that relevant information is communicated to the MEC and Board of Directors who retain responsibility for oversight. - Notifies applicant, appropriate hospital personnel and director within seven days of any actions taken
  • Monitors temporary privileges and processes requests in accordance with departmental policies and procedures and medical staff policies, bylaws, rules and regulations to ensure qualified patient care. - Upon receipt of a complete application, initiates information, collection, verification, and documentation process per established policies and procedures and cognitive analysis of all information received. Evaluates adequacy and quality and pursues additional information as necessary - Coordinates and facilitates review/recommendation and approval processes. - Communicates relative information to applicant and appropriate hospital personnel and establishes necessary files.
  • Coordinates and facilitates both informal and formal credentialing review/recommendation and approval processes. - Maintains the MSO Credentialing database to ensure accurate information - Monitors expirables (DEA, CDS, licensure, medical malpractice insurance) and maintains and updates the credential file (electronic and/or hard copy) - Conducts routine quarterly audits of the credentialing files to assess compliance with bylaws, rules and regulations
2. Communication
  • Effectively communicates issues and ongoing status of assigned work to the Director, Medical Staff Services
  • Assures that the Credentials Program operates effectively and efficiently: - Supervises and acts as a supportive resource to staff and users - Assures that human resources are managed in accordance with hospital policy and procedure - Maintains operating processes and management of staff resources that support effective and efficient delivery of departmental services. - Assures that all staff has the tools and training necessary to perform their job functions (i.e. credentials orientation, etc.) - Assures that workflows, information systems and credentialing and privileging policies and procedure are current and appropriately maintained.
3. Technical Tasks
  • Provides guidance, technical and administrative support to credentials committee and medical staff department including planning and organizing supporting documentation for committee activity. Also develops methods for addressing committee needs in a timely manner.
  • Maintains adherence to confidentiality standards established within the department and in accordance with legal, ethical, and hospital policies. Ensures data security and confidentiality by use of confidential password system, appropriate labeling of information and storage, and appropriately secured cabinets and drawers.
4. Other Duties as Assigned
  • Performs other duties as assigned or requested such as reception, filing, correspondence or other activities to support the general operations of the Medical Staff Services Department.
Qualifications
  • 2 years professional level experience
  • Bachelor's Degree or Equivalent professional level experience
  • Microsoft Applications, Computer Literacy, Data Entry, Internet Searching Abilities

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