Credentialing Coordinator

Description

Build and maintain a successful working relationship between company and network practitioners to

ensure a stable and qualified practitioner network. Facilitate successful activation and maintenance of practitioners

by performing initial credentialing, ongoing monitoring, and recredentialing processes of all required network

practitioners in accordance with industry standards. Communicate daily with outsourced vendors, healthcare facility

points of contact/professionals, as well as with internal staff to maintain a detailed and compliant practitioner

credentialing file. As part of the Credentialing Team, ensure the practitioner network meets or exceeds quality,

contract, and credentialing expectations to foster continued quality improvement and risk management efforts.

Identify and document credentialing, compliance and contract requirements as they enroll in companys

network, including the creation and maintenance of practitioner records within databases.

Initiate credentialing processes, retrieve, verify/ follow up on all credentialing applications and supporting

documentation needed for Companys practitioner network. Ensure credentialing applications are

complete, data integrity is intact within databases to meet requirements for primary source verification and

industry standards.

Perform quality reviews on credentialing files throughout each credentialing cycle.

Monitor and facilitate complete and accurate re-credentialing of practitioners on a 3-year cycle.

Act as the liaison between the practitioner network and internal departments to troubleshoot issues or

answer any questions/concerns.

Ongoing monitoring of credentialed network for accuracy or any change in status to include regular internal

practitioner record audits.

Submit appropriate practitioner records to CVO (Certified Verification Organization) or other credentialing

vendor, if applicable. Retrieve and review CVO or other credentialing vendor files as completed, if

applicable.

Schedule and act as facilitator/recorder of credentialing committee meetings on all credential files in need

of review. Notify practitioners of decisions.

Submit background checks as required on credentialed practitioners to contracted vendor. Retrieve and

review the completed background check reports as part of the credentialing packet.

Update practitioner statuses as applicable based on the credentialing committee decisions.

• credentialing
• outbound calls
• Process documentation
• Health information technology

• Associates Degree in Health Information Technology, Business or related field (health care emphasis preferred) combined with a minimum 1-year credentialing or healthcare experience required
• Equivalent combination of education, experience and/or applicable military experience will be considered
• Knowledge of healthcare terminology, electronic file/database management
• Proficient telephone skills
• Database experience
• Proficient in effectively using Microsoft Office programs
• Excel experience (spreadsheet creation and use of basic functions and formulas)
• Proficient in working with electronic files and documents
• Ability to perform detailed work with a high degree of accuracy
• Ability to think analytically, multi-task, and practice effective time management skills
• Ability to work independently, as well as with a team
• Ability to navigate multiple websites and databases
• Ability to demonstrate an appropriate level of assertiveness in performing work responsibilities under tight deadlines
• Strong analytical thinking, multi-tasking, organizational and time management skills
• Excellent professional verbal and written communication skills and ability to effectively communicate with a diverse group of individuals/teams at all levels of an organization
• Abi…