Credentialing Coordinator

Description

Credentialing Coordinator

POSITION PURPOSE

The Medical Staff Credentialing Specialist is responsible for processing physician/practitioner appointment and reappointment applications. Duties include application review, preparation of verification letters and provider database maintenance. Initiates contact with medical office staff, licensing agencies and insurance carriers as part of the credentialing process. The Medical Staff Credentialing Specialist also provides clerical support for the Medical Staff Office, maintains provider files and responds to information and credentialing requests from other healthcare entities. May assist with maintenance of Medical Staff Bylaws, Call Schedules/Scheduling and Committee Meetings as appropriate.

Requirements

POSITION QUALIFICATIONS

Education:

Post-secondary education or vocational training in related field is preferred.

Bachelor's degree in healthcare discipline is strongly preferred. Must be able to read and write the equivalent of eighth grade English.

Experience:

Three to five years of progressive administrative assistant experience within a healthcare setting is preferred. Demonstrated proficiency in Microsoft Word, Excel and Power Point software programs, verbal and written communication, customer service, and schedule coordination.

Position strongly prefers healthcare credentialing experience. Strong working knowledge of Microsoft Office applications is required.

Licenses/Certificates:

Notary Public designation is preferred.

Working Conditions:

Works in a clean, well-lighted, air conditioned office environment. Travel to affiliated healthcare facilities or events is required. Regularly exposed to the risk of bloodborne/airborne disease; contact with patients under a wide variety of circumstances; exposed to unpleasant elements (accidents, injuries, chemicals and illness); subject to varying and unpredictable situations; able to handle emergency, crisis or pressured situations; subject to multiple interruptions; occasionally subject to extended or irregular hours; requires judgment/actions that impact patient outcomes.

VISUAL AND HEARING REQUIREMENTS

Must be able to see with corrective eye wear.

Must be able to hear clearly with assistance.

May be exposed to infectious and contagious diseases. May be in contact with patients in a wide variety of circumstances. Able to handle emergency or crisis situations. Occasionally subject to irregular hours. May be required to wear protective equipment as necessary.

General Duties

• Initiates the initial credentialing and credentialing process for medical staff and allied health professionals; coordinates with Human Resources regarding employment requirements; coordinates orientation of new medical staff and allied health professionals; coordinates initial and on-going education/re-education; identifies educational needs of staff and makes recommendations to department director for ongoing staff development and/or training.
• Maintains current and confidential Medical Staff and Allied Health files; including timely notification, tracking and filing.
• Provides support for the Medical Staff office, on-call system; attends, records and/or transcribes minutes of Credentialing related meetings, Bylaws Committee and other related gatherings as requested.
• Acts as a communication liaison between medical staff departments and administration; ensures timely distribution of information to providers; demonstrates knowledge and good working communication skills as appropriate for provider and facility relations.
• Performs periodic documented file audits; maintains files for survey and/or audit readiness; maintains updated knowledge of Joint Commission regulations, Medical Staff Bylaws, Rules and Regulations, and other areas related to credentialing, makes necessary file and process updates.
• Maintains fiscally responsible office and medical supply inventory; places orders for supplies; ensures that office equipment is maintained in proper working condition; initiates service requests.
• Runs requested status reports; participates in data compilation for administrative review, audits and (re)accreditation for site visits.
• Enhances growth and development through participation in relevant educational programs, current literature, in-services and meetings.
• Timely reporting and documenting of unexpected incidents or adverse events, including participation in investigations and completion of incident reports as applicable.
• Adequately prepares for and anticipates physician & provider needs; communicates needs to appropriate department.
• Participates in department special projects; provides administrative support to the department; able to provide department leadership is absence of the Director/Manager.

Standards for Customer Service

1. Treats customers as the most important part of job.
2. Listens to customer.
3. Takes actions to appropriately and successfully addresses customer issues.
4. Demonstrates respect for diverse cultures of all patients, families and co-workers.
5. Honors the CHS Customer Service Standards and the Employee Commitment Contract.
6. Communicates with customers using AIDET with every encounter. 
7. Understands department-specific HCAHPS results.

Standards for Safety

1. Follows safety guidelines in safety manual.
2. Knows RACE procedures, location of closest fire extinguisher.
3. Speaks up for safety and reports potential safety issues to leader.
4. Attends all required safety education programs.
5. Provides complete and accurate response to safety questions.
6. Participates in unit or departmental Safety Huddle to maintain situational awareness of at-risk patients or procedures, safety critical situations or conditions, and any deficiencies that will impact safe, quality care. 
7. Incorporates “SAFE” error prevention behaviors and tools into daily practice. 

Standards of Employment

1. Attire is professional, neat, clean and appropriate for work preformed and wears proper identification while on duty.
2. Maintains confidentiality of hospital and patient information at all times.
3. Employee has completed the required Annual Mandatory Education within the past twelve (12) months.
4. Consistently follows attendance policy.

Standards of Quality Improvement/Innovation

1. Identifies and challenges work processes.
2. Works toward continuous improvement based on customer needs.
3. Contributes new ideas, makes helpful suggestions for change.
4. Works effectively as a part of the team, participates and supports group efforts.

Department/Job Specific Competencies

1. Handwashing / Infection Control
2. Security Awareness
3. Privacy Awareness