What are the responsibilities and job description for the Credentialing Coordinator position at Palm Medical Centers?
Overview
The Credentialing Coordinator is responsible for leading, coordinating, monitoring, and maintaining the credentialing and re-credentialing process. Facilitates all aspects of credentialing, including initial appointment, reappointment, as well as clinical privileging for providers.
Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws relating to credentialing. Responsible for the accuracy and integrity of the credentialing database system and related applications.
Key Duties & Responsibilities:
Required Skills/Abilities:
High school diploma or GED; at least 3 years of experience with 1 year directly related to medical office staff or managed care credentialing. Certification/Licensure NAMSS Certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS) or actively pursuing certification is preferred.
Physical Requirements:
The Credentialing Coordinator is responsible for leading, coordinating, monitoring, and maintaining the credentialing and re-credentialing process. Facilitates all aspects of credentialing, including initial appointment, reappointment, as well as clinical privileging for providers.
Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws relating to credentialing. Responsible for the accuracy and integrity of the credentialing database system and related applications.
Key Duties & Responsibilities:
- Leads, coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility.
- Research and primary source verification of all components of the application file.
- Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.
- Prepares credentials file for completion and presentation to Health System Entity Medical Staff Committees, ensuring file completion within time periods specified.
- Processes requests for privileges, ensuring compliance with criteria outlined in clinical privilege descriptions.
- Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and privileging issues as they arise.
- Assists with managed care delegated credentialing audits; conducts internal file audits.
- Utilizes the Cactus credentialing database, optimizing efficiency, and performs query, report and document generation; submits and retrieves National Practitioner Database reports in accordance with Health Care Quality Improvement Act.
- Monitors the initial, reappointment and expired process for all medical staff, Allied Health Professional staff, Other Health Professional staff, and delegated providers, ensuring compliance with regulatory bodies (federal and state), as well as Medical Staff, Rules and Regulations, policies and procedures, and delegated contracts.
- Performs miscellaneous job-related duties as assigned.
Required Skills/Abilities:
- Excellent verbal and written communication skills.
- Excellent customer service and phone skills.
- Excellent organizational skills and attention to detail.
- Excellent time management skills with a proven ability to meet deadlines.
- Proficient with Microsoft Office Suite or related software.
- Knowledge of related accreditation and certification requirements.
- Knowledge of medical credentialing and privileging procedures and standards.
- Ability to analyze, interpret and draw inferences from research findings, and prepare reports.
- Working knowledge of clinical and/or hospital operations and procedures.
- Informational research skills.
- Ability to use independent judgment to manage and impart confidential information.
- Database management skills including querying, reporting, and document generation.
- Ability to make administrative/procedural decisions and judgments.
- None
High school diploma or GED; at least 3 years of experience with 1 year directly related to medical office staff or managed care credentialing. Certification/Licensure NAMSS Certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS) or actively pursuing certification is preferred.
Physical Requirements:
- Prolonged periods of sitting at a desk and working on a computer.
- Must be able to lift up to 10 pounds at times.
This is a Remote position.
Salary : $50,000 - $60,000
