Centralized Credentialing Coordinator

The Centralized Credentialing Coordinator completes the credentialing process for medical staff membership and/or clinical privileges in accordance with the appropriate Joint Commission standards and other regulations. Identifies extraordinary information, discrepancies, time gaps and obtains additional explanation and information as required. Provides assistance with questions and directs staff to appropriate resources to educate.

Job Responsibilities

• Processes practitioner applications for initial appointments and/or reappointments. Communicates status of application to practitioners and all interested parties on a regular basis per policy.

• Manages, supports and maintains credentials files on all medical staff members and advanced practice providers. Consults and works with other hospital departments to coordinate process.

• Assures compliance with regulatory requirements and accrediting body standards, Bylaws and policies and maintains current knowledge.

• Plays a proactive role in improving processes within the department for maximum efficiency by participating/leading process improvement activities.

• Appropriately identifies, communicates and investigates extraordinary information, time gaps and potential discrepancies and adverse information, and independently investigates and validates information on applications, primary source verifications or other sources.

• Manages, supports and maintains the Network Insurance Credentialing process for employed practitioners.

• Completes audit updates on Network Insurance files.

• Obtains additional information for all Network Insurance applications with pending and closed lawsuits per policy.

• Works to ensure applications are completed within the required timeframe to meet the appropriate Credentialing Committee Deadlines whenever possible.

• Reviews Privilege request forms for accuracy and provides criteria as appropriate. Notifies practitioner that privilege will be withdrawn if criteria not received by deadline.

• Complete evaluation of pre-application/application to determine applicant's initial eligibility for membership.

• Maintain credentialing database continuously and consistently to ensure that accurate and current information is available to all stakeholders.

• Provides mentorship to credentials specialists. Assists with orientation of staff and provides direction to department resources.

• Provides assistance with questions and directs staff to appropriate resources to educate.

• May perform other duties as assigned.

Additional Requirements

Experience

• 2 years experience in a healthcare setting or customer service ; Medical Staff Credentialing is highly preferred.

Education

• High School or GED High School diploma or equivalent