Credentialing Coordinator
Found in: Resume Library US A2 - 7 days ago
The Credentialing Coordinator supports departmental activities to ensure quality in conducting, maintaining, and communicating physician credentialing, privileging, and primary source verifications.
Determines applicant's initial eligibility for membership/participation. Analyzes application and supporting documents for completeness and informs the practitioner of the application status, including the need for any additional information.
Facilitates the re-credentialing/reappointment process for eligible providers.
Compiles, evaluates, and presents the practitioner-specific data collected for review by one or more decision-making bodies. Processes requests for privileges.
Obtains and evaluates information received from primary sources.
Recognizes, investigates, and validates discrepancies and adverse information obtained from the application, primary source verifications, or other sources.
Participates in ongoing assessment of governing documents (bylaws, rules and regulations), standards and policies to ensure continuous compliance.
Displays entry level knowledge of key functions, terminology, and work products of legal, information technology, risk management, and performance concepts.
Possesses beginning to working knowledge of subject matter.
May verify and document expirables using acceptable verification sources to ensure compliance with accreditation and regulatory standards.
May collaborate with physician leaders to develop and maintain a facility-specific, criteria-based clinical privileging system in accordance with regulatory requirements, accreditation standards, and organizational policies.
May coordinate meetings of the medical staff organization.
May coordinate and develop provider on-boarding processes (orientation, training activities, and IT access).
May conduct, participate in, and maintain focused and ongoing professional practice evaluation processes for privileged providers.
May facilitate event reporting incidents through the medical staff leadership including documentation of resolution.
May observe audits of regulatory and/or delegated credentialing entities.
Performs other duties and responsibilities as assigned.
Minimum Qualifications:
Education: High School Diploma or equivalent.
Experience: 0 years experience.
Licenses/Certifications: None
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Credentialing Coordinator
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