Credentialing Coordinator

Remote

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The Credentialing Coordinator is responsible for all aspects of initial credentialing/privileging and recredentialing/privileging of physicians and advanced practice providers who perform patient care services at Grady Health System. The Credentialing Coordinator independently gathers, conducts and analyzes data/information via the primary source in accordance with the credentialing/privileging standards of all applicable accrediting and regulatory agencies (TJC, NCQA, State, and Federal) as well as the Grady Health System Medical Staff Bylaws and Rules and Regulations and Grady Health System policies and procedures.

Performs the initial and re-credentialing of Grady employed providers with all managed care plans and third-party payors through delegated processes in accordance with standards of the Grady Health System policies and procedures, Medical Staff Bylaws, and Grady Managed Care contracts.

• Communicates completion of the applications to the Medical Staff Services Director and appropriate review by the Service Chiefs.
• Assists with FPPE and OPPE collection.
• Coordinates the credentialing/ privileging process for assigned physicians and advanced practice providers
• Acts independently to process credentialing/ privileging applications for physicians and advanced practice providers.
• Maintains thorough understanding of TJC, NCQA and state/federal regulatory credentialing/privileging standards.
• Responsible for the quality and integrity of provider files and meets processing quality and productivity standards.
• Performs routine file audits. Serves as a liaison for physicians and advanced practice providers navigating through the health system.
• Adheres to strict confidentiality requirements
• Analyzes provider applications for completeness, accuracy, consistency, gaps in work history, relevant references, etc.
• Verifies all credentialing/privileging elements, including but not limited to, education, training, board certification, work history, licensure and certifications, case/procedure logs, malpractice coverage, etc through a variety of primary sources as deemed appropriate per TJC standards and other applicable accrediting agencies.
• Identifies/concerns issues and initiates further data collection as needed.
• Initiates appropriate and timely follow-up information from the Medical Staff Services Department or other sources as needed.

Must possess and maintain a working knowledge of The Joint Commission, NCQA and state/federal accrediting agencies requirements/standards regarding credentialing/privileging.

Three years of credentialing/privileging experience in a hospital or managed care setting and/or Medical Staff Services, Two years of database experience.

OR

Three years minimum in progressively responsible positions in a complex business/administrative office setting, which includes working with physicians, advanced practice providers or other professional groups

Diploma