Credentialing Coordinator - Manning - Human Resources

JOB PURPOSE:

The Credentialing Coordinator processes applications for potential healthcare providers, ensuring the supporting documentation is complete. The Credentialing Coordinator also verifies that each provider's application information is accurate while adhering to internal policies and procedures and external regulatory requirements. In addition to processing applications, tracking license and certification expirations the Credntialing Coordinator will ensure providers fulfill their renewal requirements. This role is essential to preserving the confidentiality and safety of our patients by following all federal and state regulations as well as El Rio Health internal policies.

Ensures healthcare professionals and services meet all established federal and state standards, as well as all appropriate regulatory body requirements.

Essential Job Functions:

Processes initial and recredentialing applications and reappointment, checking for full completeness and accuracy.
Collects and verifies required credentialing and recredentialing documentation, including, but not limited to primary source verification, licensure, and regulatory databases.
Preserves the confidentiality of provider information and records through proper credentialing.

Tracks license and certification expirations to confirm renewals.
Maintains accurate information for all providers, updating their credentials as necessary.
Complies with external audits.

Maintains regular cooperation and compliance with all regulatory, accrediting, and membership-based organizations.
Implements and carries out internal credentialing processes related to licensed independent providers.
Ensures that all personnel and services adhere to facility and staff policies, department guidelines, regulations, and government laws.
Prepares records for regular auditing, as well as maintains close communication with all appropriate practitioners to ensure that records are up-to-date and consistent.

Identifies discrepancies in information and conducts follow up.
Conducts data analysis and evaluations of all completed credentialing files.

Performs all assigned administrative projects, duties, tasks, responsibilities, and assignments supporting organizational operations within established time frames; meeting established rates of performance for the quality and quantity of work for the position; demonstrating a level of self-initiative, quality, efficiency, and accuracy in the employee's job performance that ensures the highest standards of excellence.
Understands and complies with all organizational Code of Conduct standards, Policies and Procedures, and Service Excellence requirements with all patients, visitors, employees, and internal/external clients or representatives.

Maintains a clean, safe, and hygienic work environment in compliance with all Policies and Procedures including but not limited to work areas, workstations, examination rooms, hand washing, infection prevention and control etc. for this position.
Demonstrates an understanding of and proficiency with the application of all compliance and reporting requirements respective to Joint Commission Certification (JCC) standards.

Serves as a contact point and informational resource for credentialing operations; tracking and ensuring that any issues, complaints, problems, or requests are brought to a timely and effective resolution.
Demonstrates the comprehensive and specialized knowledge, understanding, and technical skills of organizational credentialing operations to complete all assigned administrative projects, duties, tasks, responsibilities, and assignments, such as:

Successfully performs all functions utilizing organizational operating systems, programs, and/or business software.
Generates and distributes scheduled, or ad hoc system reports and/or summary information, as assigned or requested for departmental leadership or staff, as well as other internal/external clients or representatives through utilization of available reporting programs linked to credentialing databases, programs, or systems.
Serves as project coordinator for small team projects; handling matters proactively, expeditiously, and…