Coordinator, Credentialing
3 weeks ago
Responsible for coordinating, monitoring and maintaining the credentialing and re-credentialing process. Facilitates all aspects of credentialing, including appointment, reappointment, monitoring and privileging for medical staff and allied health practitioners. Ensures compliance with the accrediting and regulatory agencies (i.e., Joint Commission and NCQA) in regards to credentialing while developing and maintaining a working knowledge of the statutes and laws. Responsible for the accuracy and integrity of the credentialing and clinical privileging database system and for ensuring the timeliness of credentialing / re-credentialing verification. Works under the supervision of the Medical Staff Services Director. Duties include the gathering, verification and evaluation of confidential healthcare provider credentials, as well as contacting and following up with contracted network facilities to obtain documentation relevant to the credentialing process and data entry of all credentialing information provided by contracted facilities.
Responsibilities:
Broad base of understanding, integration and application of BUHMC — Credentialing policies and procedures.
Accurate review of provider application or reappointment application packet for completeness and accuracy for the timely submission to the Credentialing Committee and subsequent venues for provider appointment to meet regulatory, insurance and organizational requirements.
Knowledge of and implementation of NCQA standards for participation and preparation of physician files for audits.
Collects, verifies and ascertains information needed for processing new applications, reappointments, temporary privileges, etc.
Accurate input of initial and ongoing data elements recorded in the credentialing software system.
Completion of Credentialing Checklist as operational control for internal credentialing processes.
Creates and maintains accurate logs for mail, new applications, re-appointments and system generated letters and tracks progress of same.
Responds to inquiries for physician verification in an accurate and timely manner.
Facilitation in the depth investigation and documentation required for remediation and management of "red flags issues for Credentialing Committee determination / appropriate follow through.
Collection of required documentation with respect to the Delineation of Privileges for new appointments to the Medical Staff.
Recognition of data verification triggers and conducts data validation as needed.
Facilitate enrollment, communications and reporting for the enrollment of providers with third party insurers.
Recognition of data verification triggers; conducting data validation — data integrity efforts on as needed basis
Develop and distribute ad hoc report requests as requested.
Self-directed, Independent organization of work efforts with a high degree of accuracy.
Demonstrates ability to prioritize work and meet deadlines.
Participates in the Department's performance improvement activities.
Maintains patient/employee confidentiality in the management of information.
Perform other duties when necessary.
Qualifications:
Education:
College degree preferred or an equivalent of education plus relevant experience in a healthcare environment.
Experience:
Minimum three (3) years of related experience in a healthcare setting.
Cactus Credentialing System.
Knowledge and Skills:
Excellent interpersonal and communication skills required.
Ability to prioritize work in an environment with multiple interests.
Ability to work independently with minimal supervision.
Ability to handle complex and confidential information with discretion.
Competency using a variety of computer software.
Ability to fully utilize BHMC's electronic record systems, equipment and healthcare and billing systems relevant to this position.
Licenses, Certifications:
Certified Provider Credentialing Specialist - CPCS preferred.
Physical Requirements:
Position requires prolonged periods of sitting and use of a computer and screen viewing throughout the working day.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The statements herein are intended to describe the general nature and level of work being performed by employees, and are not to be construed as an exhaustive list of responsibilities, duties, and skills required of personnel so classified. Furthermore, they do not establish a contract for employment and are subject to change at the discretion of The Brookdale Hospital Medical Center.
BHMC is an equal opportunity employer, it is our policy to provide equal opportunity to all employees and applicants for employment without regard to race, color, religion, national origin, marital status, military status, age, gender, sexual orientation, disability or handicap or other characteristics protected by applicable federal, state, or local laws.
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