Credentialing Coordinator

Overview:

The Credentialing Coordinator plays a vital role in the effective function and coordination of the credentialing and re-credentialing process at AHMC Healthcare. This position is responsible for ensuring the timely and accurate processing of medical staff applications and reapplications, in accordance with each AHMC hospital's medical staff bylaws, policies, TJC, and Title 22 requirements.

Responsibilities:

1. Process applications and reapplications in a timely and accurate manner, ensuring compliance with AHMC hospital policies and procedures.
2. Comply with federal, state, and local healthcare regulations, as well as HIPAA and privacy regulations.
3. Communicate effectively with internal and external resources, including physicians, external agencies, administration, nursing department, risk management/performance improvement department, and medical records department.
4. Report to the CVO Director and keep them informed of potential problems relating to pending applications or reapplications.
5. Process reapplications timely and prior to the expiration of the current appointment.
6. Obtain pertinent information on malpractice claims, data banks reports, AMA profiles, etc. and relay the information to the immediate supervisor and the appropriate AHMC hospital.
7. Demonstrate thorough knowledge of the credentialing, appointment, reappointment, and profiling process, including knowledge of MD-Staff.
8. Understand various AHMC hospitals and departmental operations, policies, and procedures, and apply them to any situation.
9. Understand the organizational structure of the AHMC healthcare CVO and various AHMC hospital medical staffs, and apply knowledge in relationships with others.
10. Independently recognize and perform duties that need to be done without being directly assigned, establishing priorities, organizing work, and time to meet them.
11. Recognize and respond to priorities, accept changes, and new ideas, and have insight into problems and the ability to develop workable alternatives.
12. Understand and abide by all departmental policies and procedures, as well as the Codes of Ethics, HIPAA requirements, and patient rights.
13. Comply with federal, state, local laws that govern business practices, and comply with all Department of Health Services requirements for the State of California, and HCFA standards that apply to the position.
14. Demonstrate knowledge and adhere to JCAHO/DHS/CMS standards specific to the position.
15. Conduct business in an ethical and trustworthy manner at all times when dealing with patients, visitors, physicians, and fellow employees.
16. Understand, respect, and display sensitivity to culture, age, and persons with disabilities, and participate actively and positively in customer service activities.

Qualifications:

1. Two (2) years of credentialing experience in a hospital medical staff office.
2. College degree preferred.
3. Knowledge of federal, state, and local healthcare regulations.
4. Knowledge of HIPAA and privacy regulations.
5. Possess excellent grammar, composition, and communication skills.
6. Ability to communicate effectively with internal and external resources.
7. Excellent oral and written skills.
8. Ability to work independently.
9. Must possess excellent human relation skills.
10. Must possess excellent critical thinking skills.
11. Possess strong organizational skills with ability to multi-task, and prioritize workload.
12. Ability to interpret, prepare, and present reports to management in both written and oral formats.
13. Ability to make presentations, design, and provide training education to staff and management.