Medical Staff Coordinator/Full-time

Schedule: 40 hrs per week; M-F, Days

Position Summary: The Medical Staff Coordinator is responsible for ensuring providers are credentialed, appointed, and privileged with health plans, insurance companies, hospitals and patient- care facilities, and is responsible for maintaining up-to-date data for each provider in credentialing databases and online systems, ensuring timely renewal of licenses and certifications.

Essential Duties:

• Maintains and manages physician and Allied Health credentialing files according to DNV requirements.
• Compiles, evaluates, and presents the practitioner-specific data collected for review by one or more decision-making bodies. Processes requests for privileges.
• Prepares monthly schedules for Medical Staff and Emergency Physicians and distributes to all parties in a timely manner.
• Identify any issues or trends and bring them to the attention of management team.
• Maintain strict confidentiality of all practitioners records, data, correspondence and occurrences.
• 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.
• File, scan and copy materials and documents.
• Obtains and evaluates information received from primary sources.
• Input and maintain practitioner data in computer database. Review, research and verify practitioner files and computer database records to obtain information and compile data for reports.
• Completes provider credentialing and recredentialing applications; monitors applications and follows-up as necessary.
• Completes the payor credentialing process with all applicable insurance carriers.
• Enter and maintain system profiles/databases used for storing provider billing numbers.
• Help with Resident and student credentialing when applicable.
• Manage provider resignations and new provider notices
• Launch and process reappointment applications.
• Participates in ongoing assessment of governing documents (bylaws, rules and regulations), standards and policies to ensure continuous compliance.
• Perform essential credentialing activities related to credentialing and recredentialing operations. Organize project work, maintain inter-departmental contacts regarding credentialing issues, and maintain credentialing status report.
• Prepare and disseminate Medical Staff Board Letters.
• Prepare and disseminate professional correspondence.
• Prepare monthly reports for Medical Executive Committee.
• Prepare reports and written summaries on practitioners with adverse actions identified during the credentialing process for the Credentialing Committee and develop meeting materials in preparation of the monthly meeting.
• Review monthly reports to ensure all practitioners complete recredentialing in accordance with the assigned target date. Perform projects including generation and review of reports and data entry corrections to improve system integrity and compliance.
• Process medical staff dues, stipends and application fees.
• Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all physicians.
• Maintain database regarding address changes, personal data.
• Audits health plan directories for current and accurate providers.
• Maintain familiarity with requirements of National Practitioner Data Bank (NPDB), State Medical Boards, the National Committee of Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS) credentialing policies and procedures and other requirements as applicable.
• Maintain professional and effective working relationships with providers and other hospital personnel.
• Maintains knowledge of current health plan and agency requirements for credentialing providers.

• High School Diploma or equivalent required.
• Certified as a Provider Credentialing Specialist (CPCS) by the National Association Medical Staff Services (NAMSS) preferred.
• 2 years of medical office experience required.
• Must have strong written and verbal communication skills and a solid understanding of Microsoft office programs.
• Must be highly organized and possess strong interpersonal skills.
• Knowledge of credentialing, medical terminology and National Committee for Quality Assurance (NCQA) standards preferred.
• Proficient use of Microsoft Office applications (Word, Excel, Access) and internet resources.