Under the direct supervision of the Credentialing Manager, performs credentialing and re-credentialing in accordance with TJC, CMS, AAAHC and Medical Staff requirements for the purpose of Medical/AHP Staff membership and Privileges. The Sr. Credentialing Coordinator manages practitioner files working cooperatively with practitioners, internal departments and contract groups to ensure the seamless and timely flow of credentials information in order to meet appointment ad reappointment deadlines. Individual must demonstrate initiative, resourcefulness and problem solving skills in executing functions to ensure the orderly flow of business.
Principal Duties: 1. Coordinates UMCAP Medical/AHP Staff credentialing (initial and reappointment applications) – from receipt, to presentation to facilities for review/approval – verifying all background information, performing gap analysis, performing required primary source verifications of information on practitioner (verifying education, training, experience and competence), analyzing information obtained to ensure that membership and privilege requirements are met, within established timeframes. 2. Partners with Medical Staff Office personnel at all UMCAP facilities to ensure an integrated, timely and consistent product, with the goal of ensuring regulatory and Bylaws requirements are met, and that practitioners do not have a gap in privileges. 3. Maintain CERNER reports for all UMCAP facilities and make necessary updates in MD Staff 4. Responsible for processing Special Medical Privileges requests for all UMCAP facilities 5. Collaborates with practitioners and/or contract and practice group contacts regarding status of applications, credentialing issues, pending expirations or expirations of required licensure and certifications, or questionsand to ensure timely credentialing. 6. Collaborates with Credentialing Manager to facilitate Quality Assurance (QA) initiatives for all UMCAP facilities to include mock survey prep, file audits and database cleanup, etc. 7. Coordinate expirables process and collaborate with Credentialing Coordinators to ensure all documents are compliant in accordance with TJC, CMS, AAAHC and Medical Staff requirements 8. Performs follow up on „red flag” issues in accordance with TJC, CMS, AAAHC and Medical Staff requirements and notify applicable Medical Staff Offices of issues 9. Manages continuous credentialing process by collecting and analyzing documents and performing primary source verifications of medical malpractice insurance, licenses, prescriptive licenses, and other required certifications for membership and specific privileges. 10. Is responsible for organization of, and completion of, specific projects as required to meet new regulatory requirements and/or system changes. 11. Maintains a working knowledge of Medical Staff Bylaws of client facilities. 12. Maintains credentialing compliance with the accrediting and regulatory agencies (i.e., Joint Commission) while developing and maintaining a working knowledge of the regulations. 13. Assist Credentialing Manager with Special Projects to include Roster reconciliation, Flu Shot Campaign, Paperless project, etc. 14. Is proactive regarding participation in available educational opportunities in the credentialing field. 15. Develops and maintains personal work processes that are cohesive with credentialing objectives and goal dates, and which can seamlessly be transferred to another coordinator if required. 16. Provide supervisory back up in the absence of the Credentialing Manager Customer Service: 1. Greets customers in courteous, friendly, respectful and professional manner at all times, including maintaining eye contact when appropriate. 2. Follows communication protocols to both internal and external customers, including introducing him/herself with job title and experience, asking open ended questions, such as “How may I be of help to you?” using the customer?s name as soon as it is learned. 3. Responds promptly and appropriately to customer questions/concerns/complaints and attempts immediate.
What You Need to Be Successful:
Current Certified Provider Credentialing Specialist (CPCS) certification through the National Association Medical Staff Services (NAMSS) or must become certified within twenty-four (24) months after date of hire.
Basic Life Support – Health Care Provider (BLS-HCP)
We are an Equal Opportunity/Affirmative Action employer. ?All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.?