Credentialing Coordinator
1 week ago
Virginia Garcia Memorial Health Center is dedicated to fostering diversity and inclusivity in our workforce. We are committed to delivering exceptional, culturally sensitive healthcare to underserved populations, particularly seasonal and migrant farm workers.
Role Summary: The Credentialing Coordinator is responsible for the credentialing, privileging, and re-credentialing processes for licensed independent practitioners and other healthcare professionals. This role collaborates closely with the Billing and Human Resources departments to ensure compliance with credentialing requirements for various insurers and Medicare/Medicaid enrollment.
Key Responsibilities:
- Conduct credentialing, privileging, and re-credentialing for licensed healthcare providers.
- Perform thorough verifications of licenses, certifications, education, and training in line with organizational policies and regulatory standards.
- Ensure timely and accurate processing of credentialing applications for insurers and Medicare/Medicaid.
- Gather and maintain supporting documentation for privileging requests.
- Execute National Practitioner Data Bank queries and review professional liability claims history.
- Collect peer references and recommendations as part of the credentialing process.
- Coordinate with educational institutions for the credentialing of residents in training programs.
- Prepare credentialing applications for review by the Medical Director and Board of Directors.
- Maintain and update confidential credentialing files and provider databases.
- Monitor and notify providers regarding necessary updates to their credentials.
- Assist providers in tracking Continuing Medical Education (CME) credits and alert them of re-credentialing timelines.
- Facilitate communication between clinical leadership, providers, and administrative staff regarding credentialing matters.
- Act as a liaison to ensure smooth interactions between providers and administrative teams.
- Support the development of policies and documentation for effective credentialing processes.
- Participate in new provider orientation as required.
Qualifications:
- High School diploma or equivalent required.
- Minimum of two years of experience in a healthcare environment is essential.
- Prior experience in medical administration and credentialing is highly preferred.
- Experience in a primary care setting is advantageous.
Skills and Attributes:
- Strong organizational skills with attention to detail.
- Proficient in Microsoft Office Suite and database management.
- Excellent written and verbal communication abilities.
- Ability to manage workload effectively and adapt to changing priorities.
- Commitment to maintaining confidentiality and ethical standards.
Work Environment: This position is primarily office-based, requiring the use of standard office equipment.
Immunization Compliance: Staff members must adhere to immunization requirements as outlined in organizational policies.
Virginia Garcia Memorial Health Center is an Equal Opportunity Employer, committed to diversity and inclusion in the workplace.
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