Credentialing and Privileging Coordinator
2 weeks ago
We are seeking a highly skilled Credentialing and Privileging Coordinator to join our team at CommUnityCare. This role is responsible for facilitating the initial credentialing, re-credentialing, and privileging process for providers performing medical services at our health centers.
Key Responsibilities- Facilitate requests for initial, re-credentialing, and additional privilege applications in accordance with Credentialing and Privileging Policy/Process.
- Apply the credentials evaluation process uniformly to all initial, re-credentialing, and additional privilege applications to ensure compliance with Credentialing and Privileging Policy/Process.
- Process each initial, re-credentialing application received in accordance with Credentialing and Privileging Policy/Process.
- Compile and analyze internal data and information for an assessment of qualifications and competencies for each re-credentialing application.
- Facilitate review, assessment, and authenticated documentation for an evaluation of each application and request for clinical privileges by the Medical Director, as required.
- Facilitate review, assessment, and recommendations for each application and request for clinical privileges by the Medical Director and the Credentials Committee.
- Summarize and prepare credentialing information, including flagged concerns, for the Credentials Committee and boards review and decisions.
- Actively manage providers expiring credentials in accordance with Credentialing and Privileging Policy/Process.
- Update the Access system to reflect all board actions on a provider's initial, re-credentialing, and additional privilege requests, including resignations, terminations, LOAs, denials, terminations, or withdrawals in accordance with Credentialing and Privileging Policy/Process.
- Manage and archive files according to Credentialing and Privileging Policy and Process.
- Assist with development of eligibility criteria for each clinical privilege.
- Assist/Verify the review of requests for clinical privileges using the approved eligibility criteria.
- Assess the applicability and appropriateness of clinical privileges for each specialty.
- Maintain all up-to-date-privilege content via the List of Abilities.
- Coordinate access of Credentialed and Privileged medical staff information as needed.
- Assist with facilitating of any required regulatory agency reporting of adverse actions taken against a provider's medical staff membership or clinical privileges, as directed by facility leaders.
- Coordinate with Peer Review or designee to facilitate focused professional practice evaluation (FPPE), and any related evaluation at the conclusion of FPPE or period of review.
- Coordinate with Peer Review or designee to facilitate focused professional practice evaluation (FPPE) and ongoing professional practice evaluation (OPPE).
- Coordinate with Peer Review and Credentialed and Privileged medical Staff in the conduct of internal and external peer reviews, as applicable.
- Coordinate with Peer Review or designee the completion of a summary of FPPE, OPPE, and peer review results (e.g., performance profiles) for evaluation by medical staff leaders as part of the re-credentialing application process and/or ongoing.
- In collaboration with Peer Review, identify critical Credentialing and Privileging performance benchmarks, measure performance, and take action to improve when performance is not as desired or expected.
- MINIMUM EDUCATION: High School Diploma
- PREFERRED EDUCATION: Bachelors Degree in Business Administration, Healthcare Administration, or related field
- MINIMUM EXPERIENCE: 3 years experience in a credentialing and privileging role with knowledge of ambulatory, managed care, and hospital initial and re-credentialing processes, and strong knowledge of NCQA, JC, HRSA, URAC, CMS, and TDI guidelines.
- PREFERRED EXPERIENCE: 5 years experience in a credentialing and privileging role with knowledge of ambulatory, managed care, and hospital initial and re-credentialing processes, and strong knowledge of NCQA, JC, HRSA, URAC, CMS, and TDI guidelines.
- REQUIRED CERTIFICATIONS/LICENSURE: None specified
- PREFERRED CERTIFICATIONS/LICENSURE: Certified Professional Credentialing Specialist, (CPCS) or in process of certification
At CommUnityCare, we offer a competitive salary and benefits package, as well as opportunities for professional growth and development.
We are an equal opportunity employer and welcome applications from diverse candidates.
Please submit your application, including your resume and cover letter, to [insert contact information].
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