Medical Credentialing Coordinator/Medical Credentialist

Job Summary

Aptive seeks a Medical Credentialing Coordinator/Medical Credentialist to support the credentialing process, including verifying licenses, certifications, education, training, and professional references for a healthcare staffing program. The candidate will ensure that healthcare professionals meet the necessary qualifications and credentials required for employment or affiliation with a healthcare facility.

 

Our team values a low-ego, psychologically safe and accountable work environment. We function best with a high degree of quality assurance, teamwork, open communication and collaboration. The role involves handling confidential information, providing a positive employee experience, and supporting smooth operations in alignment with company policy and government requirements.

 

This is a fully remote telework position. A hybrid work schedule is available by request for candidates within commuting distance of Old Town Alexandria, VA.

Primary Responsibilities

Credentialing Process Management:

• Oversee the credentialing process for healthcare professionals, including physicians, nurses, allied health professionals, and other staff members.
• Maintain accurate records of credentialing documentation and ensure compliance with organizational policies and regulatory requirements.
• Coordinate with internal departments and external organizations to obtain necessary credentials and verifications.
• Process applications to obtain licenses and hospital privileges on behalf of new and existing providers as needed
• Generate and send verification letters needed for licensure
• Complete all necessary and appropriate forms for PSV and file in preparation of Credentialing Committee review
• Prepare check requests for required verification fees
• Maintain and update VMS/ATS technology with status and necessary data elements
• Document all tasks, phone calls, emails and other forms of communication during the credentialing and recredentialing process in the ATS database
• Conduct written and oral follow up to determine application status
• Escalate all issues to the appropriate members of the management staff, region, and/or co-workers as necessary
• Respond promptly to all questions, received via phone or email, regarding any license and/or privilege
• Participate in the delegated credentialing audit process as needed
• Coordinates aspects of drug screen testing, criminal background checks and case logs according to site credentialing requirements
• Assists with the site credentialing process including gathering and documenting facility requirements and assisting healthcare professionals in obtaining necessary requirements to ensure assignment start dates are met

Verification and Documentation:

• Verify the accuracy and authenticity of licenses, certifications, education, training, and other credentials required for healthcare professionals.
• Collect, review, and maintain documentation related to credentials, including application forms, resumes, references, and background checks.
• Ensure that all credentialing documentation meets established standards and is kept up-to-date.
• Assesses healthcare professional credentials for deficiencies to standard and communicates to production when a healthcare professional cannot be accepted.

Compliance and Quality Assurance:

• Ensure compliance with applicable laws, regulations, and accreditation standards related to credentialing and privileging processes.
• Conduct periodic audits to assess the quality and completeness of credentialing files and processes.
• Identify and address any discrepancies, deficiencies, or issues related to credentialing.

Communication and Collaboration:

• Communicate effectively with healthcare professionals, administrative staff, and external agencies regarding credentialing requirements and processes.
• Collaborate with internal stakeholders to facilitate the credentialing process and resolve any issues or concerns.
• Serve as a resource for staff members regarding credentialing policies, procedures, and requirements.
• Communicates expiring documents to the assigned Recruiter and assist as necessary to ensure that updated documentation is collected

Continuous Improvement:

• Participate in ongoing training and professional development to stay informed about changes in credentialing standards, regulations, and best practices.
• Identify opportunities for process improvement and contribute to the development and implementation of new policies and procedures.
• Support organizational initiatives aimed at enhancing t