CREDENTIALING COORDINATOR

Description

We are an EEO employer, and all hiring practices and other terms and conditions of employment shall be maintained and conducted in a manner that ensures compliance with all applicable federal laws.

Position Summary           

This position is responsible for the credentialing and privileging of all HCHN providers.

General Responsibilities

• Maintains credentialing file system in compliance with JCAHO, HCHN policies, DOL and all other governing organizations.
• Handles all aspects of the credentialing process, including updating physicians' applications for credentialing, functions as a liaison between the credentialing organizations and HCHN, and notifying the physicians when their licenses and applications need to be updated.
• Attend training seminars and conferences to maintain knowledge of insurance and HMO requirements.
• Maintain communication between medical staff, patients and insurers.
• Credential and re-credential all physician and mid-level providers according to Health Plan specifications.
• Handles all aspects of the privileging process for providers.
• Maintain accurate, organized, and confidential credentialing and privileging files on all providers.
• Ensure all licensure, certifications, and hospital privileges are current.
• Work independently with providers and Health Plans to research and resolve credentialing-related issues.
• Works conjointly with the providers to ensure CME credits and other trainings are documented.
• Other duties as assigned.

Qualifications

Education and/or Experience

• Associates degree in related field from an accredited college or university OR at least five (5) years of equivalent experience is required;
• Bachelor’s Degree preferred. 
• Previous experience credentialing physicians and mid-level providers or at least two years of work experience in a health care or human service related organization.

OR

• Equivalent combination of education and experience requirements sufficient to successfully perform the duties of the job as listed above.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Ability to maintain confidentiality in all matters.
• Ability to formulate decisions and make judgments that are demanding and interpretive. 
• Flexible, with the ability to work independently and with minimal guidance.  
• Excellent concentration skills and must be detail oriented.
• Extensive working knowledge of Microsoft Office.
• Excellent interpersonal and customer service skills, to effectively and tactfully deal with a diverse group of patients, staff, customers, and community groups.
• Ability to communicate effectively with diverse populations.

Physical Demands           

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to talk or hear. 
• The employee frequently is required to stand, walk, sit; use hands to handle or feel; reach with hands and arms; and stoop, kneel, or crouch. 
• The employee must occasionally lift and/or move up to 25 pounds.
• Specific vision requirements include the ability to see at close range.
• Fine hand manipulation (keyboarding).

Work Environment          

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

• Internal office space. 
• The noise level in the work environment is usually moderate.