Credentialing Coordinator

3 weeks ago

Houston Texas, United States CommonSpirit Health Full time
Overview:
Baylor St. Luke’s Medical Center is an internationally recognized leader in research and clinical excellence that has given rise to breakthroughs in cardiovascular care neuroscience oncology transplantation and more. Our team’s efforts have led to the creation of many research programs and initiatives to develop advanced treatments found nowhere else in the world. In our commitment to advancing standards in an ever-evolving healthcare environment our new McNair Campus is designed around the human experience—modeled on evidence-based practices for the safety of patients visitors staff and physicians. The 27.5-acre campus represents the future of healthcare through a transformative alliance focused on leading-edge patient care research and education. Our strong alliance with Texas Heart® Institute and Baylor College of Medicine allows us to bring our patients a powerful network of care unlike any other. Our collaboration is focused on increasing access to care through a growing network of leading specialists and revolutionizing healthcare to save lives and improve the health of the communities we serve.

Responsibilities:
Coordinates credentialing activities at the Division level including data entry and physician database maintenance; credentialing processes, expirables and other duties that support provider onboarding activities.  Serves as effective liaison between provider and the facilities throughout the credentialing process.  Responsible for understanding State and Federal Regulatory Agencies requirements, accreditation compliance and other critical matters that affect the healthcare environment as it relates to the credentialing process.  Performs other duties as assigned in an effective competent manner.

 

POSITION RESPONSIBILITIES

Initiates and coordinates the collection of primary source information for credentialing purposes at the division level.  Verifies, compiles, manages and maintains confidential research required for credentialing of initial appointment and reappointment applicants.  Processes applications according to established legal, State and Federal agencies, State licensing board, regulatory and facility standards.  Coordinates, tracks, and monitors flow of information to ensure the timely processing and notification of applicants in accordance with the guidelines established.

Conducts thorough analysis of all primary source documentation received for assessment of qualifications/competencies.  Assures appropriate education and training including procedural documentation has been provided to support clinical privileges requested.  Identifies any potential quality of care issues, behavioral problems, and/or other issues, escalating as necessary.  Summarizes and prepares credentialing information, including information about flagged concerns, for review and decisions.  Applies the credentials evaluation process uniformly to all initial appointment and reappointment applications to ensure compliance with St. Luke’s Health credentialing policies, procedures and applicable Medical Staff Bylaws.  Compiles information regarding CME credits and other requirements in accordance with state licensing requirements and Division policy. 

Facilitates review and assessment of documentation for each application.  Serves as the Central Verification Office (CVO) primary point of contact for practitioners during appointment and reappointment process.  Must be available to guide practitioners through the process and clearly communicate requirements. 

Maintains an accurate, secure and current database of physician and advanced practitioner/allied health professional information.  Proficient with MSOW, Cactus or similar credentialing platform.  Follows data entry policy. 

Appropriately escalates concerns regarding credentialing documents and/or timeliness of the verification process.  Communicates with facilities appropriately and in a timely manner according to policy.  Maintains confidentiality.

Monitors and maintains all required expirables.

Provides clerical support including filing, routing mail, scheduling and attending meetings, generating reports as required.

Supports system and division standardization efforts.  Participates in identifying and implementing best practices.

Qualifications:
MINIMUM QUALIFICATIONS

Experience – Minimum of one (1) year of experience in medical staff services, hospital administrative department or credentialing verification organization.  Comparable healthcare or managed care work experience may be considered.

Education – High School diploma

Licensure/Certification – None required

 

Highly Preferred Skills and Abilities:

Critical thinking skills

Organized, detailed oriented and able to effectively multi-task

Computer Literate

Working with HIGH Volume

Flexible and Adaptable

Minimum Knowledge, Skills, and Abilities:

Credentialing database experience, MSOW or Cactus preferred

Proficiency in Microsoft Office and/or Google Workspace

Excellent written and oral communication skills

Excellent data entry skills; detail-oriented, ability to prioritize tasks

Ability to work remotely while maintaining confidentiality, communicating appropriately and completing assignments according to deadlines

Ability to comprehend and follow instructions; maintain attention and concentration for necessary periods.

Ability to synthesize, coordinate, and analyze data, perform simple and repetitive tasks and maintain a work pace appropriate to given workload.

Perform varied tasks; relate to other people beyond giving and receiving instructions in stressful situations, get along well with customers, co-workers and peers;

Understand the meaning of words and how to use them appropriately and effectively; make appropriate decisions or exercise judgement based on appropriate information while elevating questions and concerns to the supervisor.

Accept and carry out responsibility for direction, control and planning of day-to-day workload

 

DISCLOSURE STATEMENT:

The above statements reflect the general details considered necessary to describe the essential functions of the job as identified, and shall not be considered a detailed description of all work requirements that may be inherent  in position.

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