Credentialing Coordinator

Facility: VIRTUAL-GA

Job Summary:

A Credentialing Coordinator functions under the direction of the Manager of Medical Staff Services and performs all duties as directed for the system. This position is responsible for maintaining current Medical Staff and Allied Health information, managing the credentialing database, processing Medical Staff and Allied Health appointment and reappointment applications, processing verification requests, creating Medical Staff calendars and Emergency Department Call schedules, processing Medical Staff deposits and invoices as well as running reports and document scanning. This position is a vital position to the efficient functioning of the Medical Staff Services Department to ensure credentialing is completed per accreditation standards and federal regulations.

Core Responsibilities and Essential Functions:

Credentialing & Privileging: * Leads, coordinates and monitors the review and analysis of practitioner initial/reappointment applications and supporting documentation for completeness and eligibility according to accreditation standards (Joint Commission, NCQA, CMS, federal and state). Manages all communication with the practitioner related to the application status and problem resolution. Serves as a liaison between the practitioner and site medical staff coordinators. * Responsible for a thorough background investigation through research and primary source verification of all required components of the application file. * Subject matter expert in the operation of the credentialing database, optimizing efficiency, and performing queries, reports and document generation; submits and retrieves National Practitioner Data Bank reports in accordance with the Health Care Quality Improvement Act. * Identifies issues that require additional investigation and evaluation, validates discrepancies and accountable for appropriate follow up. * Collects, verifies, analyzes, and delivers practitioner-specific data obtained during the credentialing process for the review and approval of the site governing bodies to have the information necessary to make decisions in compliance with accreditation standards and federal regulations. * Processes practitioner requests for privileges by obtaining documentation of competency in compliance with accreditation standards and federal regulations. * Manages the process and the credentialing database for non-staff referring practitioners for the system. * Ensures proper transmission of practitioner data between the credentialing database and EPIC. Ongoing Monitoring: * Monitors the initial and reappointment process for all Medical Staff, Allied Health Professional staff, other Health Professional staff, and delegated providers. Validates compliance with regulatory bodies (Joint Commission, NCQA, CMS, federal and state), as well as Medical Staff Bylaws, Rules and Regulations, policies and procedures and delegated contracts. * Monitors OIG database of excluded individuals for credentialed and referring practitioners to ensure there is no violation of healthcare fraud. * Collects and maintains accurate practitioner database and analyzes verification information to include licensure, certification and malpractice insurance to maintain compliance with accreditation standards and federal regulations. * Monitors PHI fax to ensure HIPAA compliance to protect healthcare electronic transactions. Regulatory Compliance and Continuous Survey Readiness: * Participates in internal and external audits of practitioner files and operational documents (e.g., policies, procedures, monitoring logs) to maintain compliance with accreditation standards and federal regulations. * Developments and distributes monthly emergency call schedules to ensure compliance with EMTALA regulations. * Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and privileging issues as they arise. Performs other duties as assigned Complies with all Wellstar Health System policies, standards of work, and code of conduct.

Required Minimum Education:

High school diploma Required or Equivalent Required

Required Minimum License(s) and Certification(s):

All certifications are required upon hire unless otherwise stated.

• Cert Provider Credential Spec-Preferred

Additional License(s) and Certification(s):

Required Minimum Experience:

Minimum 3 years healthcare related experience. Required and Credentialing/Medical Staff Office experience Preferred

Required Minimum Skills:

Excellent verbal and written communication skills along with the ability to work with computer-based systems for data entry and extraction. Knowledge of the basic principles of credentialing and privileging. Must possess strong communication, customer service and interpersonal skills; ability to multitask, prioritize, organize and meet deadlines is essential; must be detail oriented.