Credentialing & Privileging Coordinator

Overview

Under the direction of the Credentialing Manager, the Credentialing Coordinator is responsible for coordinating all aspects of the credentialing and/or recredentialing process as well as changes in privileges/specialty or demographic information for health care professionals practicing within Comm Unity Care  health centers. This position ensures health care professionals are appropriately credentialed and privileged, including ongoing maintenance and verification of current information on file and within the credentialing database, and other duties required to maintain compliance with regulatory and accreditation agencies and Comm Unity Care  credentialing policies and procedures.

Essential Duties (at least 5 that are non-negotiable duties and are absolutely pertinent to successfully completing the job without accommodations):

• Reviews, screens, and completes initial credentialing and/or recredentialing, and additional privilege request applications for completeness, accuracy, and compliance with federal, state, local, and Comm Unity Care  regulations, standards, policies, and guidelines.
• Perform and collect primary source verification (PSV) of all credentialing elements and validates the information to ensure accuracy.
• Data entry of new applications in the credentialing database.
• Communicates clearly with providers, their credentialing representative, and leadership as needed to provide timely updates and responses on day-to-day credentialing and privileging issues as they arise.
• Analyzes, identifies, resolves discrepancies, time gaps, and other issues that could impact ability to credential healthcare practitioners.
• Report issues in a timely manner to Credentialing Manager for decision making in accordance with credentialing and privileging policy and federal state, local, and government and health plans standards.
• Provide consistent and timely follow-up on all outstanding credentialing/re-credentialing files.
• Process provider demographic changes ensuring appropriate documentation has been submitted with the changes, update credentialing database and notify health plans of changes.
• Prepare and scan credentialing/re-credentialing files and other credentialing documentation into electronic folder.
• Maintain knowledge of current requirements for credentialing providers.
• Ensure all tasks duties comply with all regulatory and accreditation standards including The Joint Commission, the National Committee Quality Assurance (NCQA) guidelines, and Comm Unity Care  Standard Operating Procedures and Comm Unity Care  Policies and Procedures.
• Responsible for monitoring and managing credentials/recredentialing requirement to ensure the collection of all required renewals are on file within their required time frame.
• Responsible for the timely entry, processing, and tracking of credentialing files.

• Ensure all actions, job performance, personal conduct and communications always represent Comm Unity Care  in a highly professional manner.
• Uphold and ensure compliance, confidentiality and adhere to all HIPAA guidelines, and maintain a strict level of confidentiality for all company policies and procedures, departmental, and healthcare provider information as well as the overall mission and values of the organization.
• Ensure that all work is done in a timely and accurate manner.
• Works within established credentialing time frames and notifies manager as to status and barriers preventing work being done in a timely and accurate manner.
• Maintain strong working relationships with providers, health plan staff, and other credentialing verification offices.
• Develop and maintain favorable internal relationships, partnerships with co-workers.
• Responsible for the monthly ongoing…