Credentialing Coordinator

Description

• Initiate, coordinate, monitor and maintain the credentialing and re-credentialing of all practitioners and allied health staff employed and/or contracted.
• Will also assist to perform duties regarding various managed-care activities
• Completion of health care professionals credentialing and re-credentialing applications including the privileging and re-privileging for all Practitioners and allied health staff employed/or contracted with all sites.
• In addition, responsible for the completion of the credentialing and re-credentialing of Other Licensed and Certified Practitioners
• Initiates and conducts primary source verification of practitioner’s background, education/training and malpractice history through the use of online systems, written correspondence, telephone inquiries and other acceptable credentialing methods
• Identifies and evaluates potential red flags and works in collaboration with the credentialing manager to determine next steps
• Performs ongoing monthly and quarterly compliance reporting
• Analysis of report data and state board sanction information in compliance with regulatory on-going monitoring requirements
• Is responsible for preparation of materials and files for presentation and review by credentialing committee
• Perform data management and reporting from credentials database
• Collaborates with inter-departmental peers, including Quality Management and Operations to identify and implement best practices and to ensure an integral, timely, and consistent product
• Works with Human Resources/Operations department/Recruitment to ensure timely credentialing of new health care professionals  

Requirements

• Any combination equivalent to: An associate’s degree AND one year of credentialing experience in a managed care setting or experience in the medical field with a thorough understanding of credentialing and privileging
• Background of strong administrative skills will also be considered
• Proven ability to function independently with minimal direct supervision required
• Strong organizational and communication skills required
• Excellent oral and written communication, interpersonal and computer skills required
• Proficient in Microsoft Office Suite (Outlook, Word, Excel)
• Comfortable extracting and formatting data for ad hoc report requests
• Attention to detail a must
• Confidentiality required