Credentialing Coordinator

4 weeks ago

Atlanta, United States SCP ENT & Allergy Services, LLC Full time

The Credentialing Coordinator is responsible for ensuring that healthcare professionals meet all necessary requirements and qualifications to obtain and maintain their credentials. This position plays a critical role in ensuring compliance with regulatory standards and facilitating the smooth operation of the credentialing process. The Credentialing Coordinator serves as a liaison between healthcare providers, insurance companies, and various internal departments to ensure timely and accurate completion of credentialing procedures. Key Responsibilities: 1. Credentialing Process Management: - Coordinate and manage the entire credentialing process for healthcare professionals, including physicians, nurses, and other allied healthcare providers. - Maintain accurate and up-to-date provider information in the credentialing database and electronic systems. - Review and verify all required documents, including licenses, certifications, and education credentials, to ensure compliance with regulatory standards and organizational policies. - Conduct thorough background checks, including primary source verification, to validate provider credentials and qualifications. - Monitor and track the progress of the credentialing process, ensuring all required steps are completed within established timeframes. 2. Provider Relations: - Serve as a primary point of contact for healthcare professionals regarding credentialing inquiries, status updates, and documentation requirements. - Collaborate with providers to obtain missing or incomplete information and address any concerns or issues related to the credentialing process. - Build and maintain positive relationships with healthcare providers, promoting effective communication and a high level of customer service. 3. Communication and Collaboration: - Liaise with internal departments, such as Human Resources, Compliance, and Medical Staff Services, to ensure seamless coordination of the credentialing process. - Communicate with insurance companies, government agencies, and external credentialing bodies to exchange necessary information and resolve any discrepancies or issues. - Facilitate and participate in credentialing committee meetings, providing accurate and comprehensive reports on provider credentialing status. 4. Compliance and Quality Assurance: - Stay abreast of industry standards, regulations, and accreditation requirements related to credentialing processes and maintain compliance accordingly. - Conduct regular audits and quality checks to ensure data integrity and adherence to established policies and procedures. - Identify opportunities for process improvement and efficiency enhancement within the credentialing process. Qualifications and Skills: - Bachelor's degree in Healthcare Administration, Business, or a related field (or equivalent experience). - Previous experience in credentialing or medical staff services preferred. - Knowledge of credentialing standards, regulations, and best practices (e.g., NCQA, Joint Commission). - Familiarity with electronic credentialing systems and databases. - Strong attention to detail and exceptional organizational skills. - Excellent written and verbal communication skills. - Ability to multitask, prioritize, and meet deadlines in a fast-paced environment. - Proficiency in using Microsoft Office Suite and other relevant software applications. The Credentialing Coordinator plays a vital role in ensuring the compliance and integrity of healthcare provider credentials, contributing to the delivery of safe and high-quality healthcare services. If you are detail-oriented, possess strong organizational skills, and thrive in a dynamic healthcare environment, we invite you to apply for this exciting opportunity.

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