Credentialing Coordinator II

JOB SUMMARY/PURPOSE

• Independently manages all activities associated within the initial and re-credentialing application process and/or the provider enrollment process, which may include primary source verification of licensure, certification and credentials for the purpose of employment; hospital privileges and health plan membership; facility credentialing; provider/facility enrollment with payers; and delegation agreement management. Acts as a subject matter expert for Primary Source Verification, Provider Enrollment and Facility Credentialing.
  
  Collaborates with Medical Staff and Samaritan Health Plan offices to ensure accuracy and completeness of files and reduce duplication of credentialing activities. Serves as a system expert for management of system wide provider database. Acts as a liaison and mentor for Credentialing Coordinator I employees.

• The Credentialing Department at Samaritan Health Services credentials new and existing healthcare providers for employment, privileging and participation in Samaritan Health Plans. The credentialing process includes verification, documentation, and approval of a practitioner’s credentials and meets the requirements of The Centers for Medicare and Medicaid and our accrediting bodies.

• High School diploma or equivalent required. Completion of college coursework preferred.
• Four (4) years experience in a position of similar responsibility and complexity, including one (1) year experience in credentialing and MSOW applications required.
• Experience and/or training in theories, concepts, and principles of secretarial science and office management required.
• Experience and/or training in regulatory compliance including The Joint Commission, DNV, NCQA and CMS as it applies to credentialing standards, required.
• Experience and/or training in medical staff structure required.
• Experience and/or training in computer applications including Microsoft Word, Outlook and Excel required.
• CPCS certification preferred.

• Computer Literacy - Knowledge of computer software, including Microsoft Office programs and web based applications. Ability to operate applications, enter data, and manipulate and process information.
• Clerical - Knowledge of theories, concepts, and principles of secretarial science and office management. Ability to perform administrative and clerical procedures.
• Credentialing - Knowledge of accreditation, NCQA, medical staff standards and state/federal requirements as they relate to credentialing services.
• Communication – Possess professional verbal and written communication skills for interacting with customers of Credentialing Department.

• Rarely
  (1 - 10% of the time)

  Occasionally
  (11 - 33% of the time)

  Frequently
  (34 - 66% of the time)

  Continually
  (67 – 100% of the time)

  CLIMB - STAIRS

  LIFT (Floor to Waist: 0"-36") 0 - 20 Lbs

  LIFT (Knee to chest: 24"-54") 0 – 20 Lbs

  LIFT (Waist to Eye: up to 54") 0 - 20 Lbs

  CARRY 1-handed, 0 - 20 pounds

  SQUAT Static (hold >30 sec)

  SQUAT Repetitive

  BEND FORWARD at waist

  KNEEL(on knees)

  STAND

  WALK – LEVEL SURFACE

  REACH - Upward

  ROTATE TRUNK Standing

  PUSH(0-20 pounds force)

  PULL(0-20 pounds force)

  SIT

  ROTATE TRUNK Sitting

  REACH - Forward

  CARRY 2-handed, 0 - 20 pounds

  MANUAL DEXTERITY Hands/wrists

  FINGER DEXTERITY

  PINCH Fingers

  GRASPHand/Fist