What are the responsibilities and job description for the Credentialing Services Coordinator - Provider Enrollment position at VIRTUA?
Job Summary:
Coordinate the credentialing of applicants for membership and reappointment in compliance with defined schedules. Collect and analyze information thoroughly to identify potential quality of care issues, behavioral problems, appropriate education and training. Prepare and manage credentialing and re-credentialing applications for completeness and accuracy, maintain and monitor steps of the enrollment and re-enrollment process. Maintain an accurate enrollment database, coordinate flow of information between Credentialing Services, Revenue and Billing departments. Investigate issues of concern, generate reports and present findings to facilitate recommendations to the Board of Trustees.
Position Responsibilities:
Process applications, including those from Allied Health professionals, for initial appointment and reappointment for Provider Enrollment Plans to the medical staff of multiple Virtua entities, in a timely manner.
Maintain required Medical Staff documents to ensure compliance, including FPPE (Focused Professional Practice Evaluation) and OPPE (Ongoing Professional Practice Evaluation) for medical staff through appointment and reappointment process.
Prepare Committee agenda and supporting material with Committee Chair. Attend meetings, record minutes, and ensure prompt follow up on actions taken by the Committee. Review “Board Actions Summary” from the state of NJ and provide follow up as necessary.
Monitor proctoring process to include timely data collection, analysis, and generate reports from credentialing database to ensure compliance with policies and procedures. Maintain and audit provider status in the enrollment database.
Coordinate flow of information between Medical Staff, Administration and other hospital departments. Initiate problem solving of any departmental roadblocks and regulatory agencies.
Demonstrate accurate knowledge of Medical Staff Bylaws, policies and procedures and external accrediting agencies, such as JCAHO, NCQA as well as state and federal regulatory agencies.
Participate in project related functions in the department, assist other team members as required, complete other duties as required to support the success of Provider Enrollment.
Position Qualifications Required:
Required Experience:
2 years of Credentialing or related professional experience required.
Knowledge of provider enrollment and regulatory requirements and issues related to role and/or department, i.e. NCQA, DOH and Joint Commission.
Team player, excellent customer service and interpersonal skills.
Excellent communication (verbal and written) and organizational skills.
Able to work independently, meet deadlines & possess knowledge of healthcare procedures
Attention to detail and accuracy is vital, well organized, reliable, flexible & responsible.
Ability to work under pressure for a demanding clientele (medical staff).
Computer literacy – Word, Excel, PowerPoint
Required Education:
High School graduate.
College graduate preferred.
Training / Certification / Licensure:
Certification by the National Association of Medical Staff Services (CPMSM or CPCS) preferred. CMSC preferred.
