Credentialing Coordinator - Integrated Credentialing - Full Time 8 Hour Days (Non-Exempt) (Non-Union)
The Credentialing Coordinator is responsible for assuring that the credentialing of practitioners is conducted in accordance with the Office of Integrated Credentialing/client policies and procedures, entity bylaws/credentialing plan, regulatory agencies, and accrediting bodies. The Credentialing Coordinator performs quality control audits and coordinates the preparation of completed practitioner files, maintains accurate records regarding the processing status of each practitioner, and flags potentially adverse information. The Credentialing Coordinator is responsible for assuring all activities are conducted as scheduled and per departmental standards.Departmental Specific SummaryEssential DutiesProcesses initial credentialing and reappointment applications, reviews for completeness, verifies information through appropriate resources, and processes the applications to Integrated Credentials Committee, as applicable, in a timely manner and as defined in Credentialing Policies and the Medical Staff Bylaws/relevant Credentialing Plan.Review all returned application materials for appropriateness and completeness, insure that documentation of all training and experience for requested privileges is provided and maintain an on-going dialogue with the applicant and other interested parties to assure that applicants are credentialed by their start/reappointment date.Follow up with client Medical Staff Offices, Departments, clients, practitioners and other respondents regarding incomplete/missing information on documents received according to OIC procedures.Maintains paper/electronic credentials files, clinical privilege forms (as assigned) and practitioner databases to insure information contained is accurate and current. Effectively utilizes all software systems to perform essential job functions, adhering to established data entry conventions.Perform electronic, written and telephonic queries to agencies providing primary source information regarding malpractice claims, licenses, certifications, training and affiliations. Assess content of responses to determine any follow up required.Processes reappointment/credentialing applications including gathering OPPE and other quality data, verification of all required elements in accordance with Credentialing Policies and Medical Staff Bylaws, Rules and Regulations, and relevant Credentialing Plan and submitting to appropriate Department Chairs/Chief/designees and committees for review.Monitor receipt of credentialing information and insure that second and third requests are sent within the defined time frame.Review all application documents and responses for appropriateness and completeness, insure that documentation of all training and experience for requested privileges is providedEvaluate the completeness and integrity of initial applicant, reappointment applicant, and annual evaluation files, and determine when all necessary verificatons and required documents have been completed and are present for ...