Credentialing Coordinator -Medical Staff Office - FT - Day

Position Status:

Shift:

First Shift (Days - Less than 12 hours per shift) (United States of America)

Hours per week:

40

Job Information
Exemption Status: Non-Exempt

A Brief Overview
The Credentialing Coordinator will assist in ensuring patient safety throughout Stormont Vail Health. This position works with the Medical Staff and Administration ensuring Stormont Vail Health (SVH), SVH Bylaws and other regulations are met through the medical staff and organizational processes. The Credentialing Coordinator is responsible for communicating information to the Credentialing Specialist, Director, Medical Staff and others as appropriate.

Education Qualifications

• High School Diploma / GED Required
• Associate's Degree Preferred

Experience Qualifications

• 3 years Experience with Microsoft office products including but not limited to; Excel, Word, and PowerPoint. Required
• 3 years Clerical experience. Required
• 2 years Prior health care industry experience. Preferred
• 1 year MD-Staff, MD-Stat experience. Preferred

Skills and Abilities

• Confidentiality, Foster team cohesiveness and collaboration & Professional Ethics. Able to build relationships. (Required proficiency)
• Ability to ask questions and to follow instructions/directions. (Required proficiency)
• Able to follow medical staff bylaws, policies and procedures. (Required proficiency)
• Able to be flexible and adaptive to time lines and situations. (Required proficiency)
• Ability to analytically think. Ability to perform clinical competence evaluations. (Required proficiency)
• Knowledge of change or database management. (Required proficiency)

Licenses and Certifications

• Certified Provider Credentialing Specialist - NAMSS CPCS or CPMSM. Preferred

What you will do

• CONDUCTS, PARTICIPATES IN, AND MAINTAINS PRIMARY SOURCE VERIFICATION: Perform outreach to primary sources for practitioners’ information. Obtain and evaluate information from primary sources. Perform detailed and thorough review of applications, primary source verifications, and sources provided. Recognize potential discrepancies and adverse information, and independently investigate and validate information from primary source verifications, or other sources. Verify and document expireables using acceptable verification sources to ensure compliance with accreditation and regulatory standards. Serve as main point of contact for external queries regarding practitioners’ status, providing responses in a timely matter.
• Complete evaluation of application to determine applicant’s initial eligibility for membership/participation. Review application and supporting documents for completeness. Serve as main point of contact for practitioner during application process, providing timely updates and additional information as requested. Determine applicant’s initial eligibility for membership/participation based on approved criteria. Compile, evaluate, and present the practitioner-specific data collected for review by one or more decision-making bodies. Perform initial or reappointment/re-credentialing for eligible practitioners. Process requests for privileges. Conduct, participate in, and maintain credentialing verification organization (CVO)
• Uniformly apply clearly defined credentialing or privileging processes to all practitioners/providers. Evaluate credentialing/privileging requests and evidence of education, training, and experience to determine eligibility for requested application, privileges and/or membership.
• Obtain and assess information from various referral sources. Recognize, investigate, and validate discrepancies and adverse information obtained. Communicates findings and/or resulting actions to Credentialing Specialist, Director, Medical Staff and department peers as appropriate/policy.
• Compile practitioner sanctions, complaints, and adverse data to ensure compliance. Demonstrate an understanding of state and regulatory standards. Demonstrate an understanding of state and regulatory standards in relation to telehealth and credentialing by proxy.
• Identify and report to their supervisor adverse actions taken against a practitioner/provider in accordance with applicable law and contractual requirements. Monitor and/or report sanctions and complaints for all practitioners/providers to supervisor. Develop informational/educational documents (newsletters, memos) to communicate critical information regarding organizational programs and policies. Develop and cultivate working rel