The Credentialing Coordinator maintains the credentialing and re-credentialing process within department. This position facilitates all aspects of credentialing including appointment, reappointment, monitoring and privileging for medical staff and allied health practitioners. Ensures compliance with the accrediting and regulatory agencies (i.e., Joint Commission, NCQA, URAC, CMS) and organizational governing documents in regards to credentialing, while developing and maintaining a working knowledge of the statutes and laws. Maintains accuracy of data in credentialing and privileging database system and ensures timeliness of credentialing/re-credentialing verification process. Duties include the gathering, verification and evaluation of confidential healthcare practitioner credentials. The Credentialing Coordinator serves as a valuable resource to Medical Staff Leadership and is a customer focused team player.
ESSENTIAL DUTIES AND RESPONSIBILITIES – Other duties may be assigned.
Assures timely processing of all credentialing/privileging functions for licensed independent practitioners, in an efficient manner, for recommendations to the appropriate committees (credentialing committee, medical executive committee, and board approval) in accordance with all governing documents, policies and procedures, and all regulatory bodies. Communicates with all applicants and coordinates with applicable managers and directors to ensure appropriate follow up and follow through. Finalizes all board letters and mail within two (2) days of board action and maintains a copy for the credentials file prior to filing. Assists with the completion of the monthly board memo to send to internal staff and others as requested of all board approved actions within two (2) days of the board meeting.
Collects and makes cognitive analysis of all information received, appropriately evaluating the quality of the documentation received, pursuing additional information, if necessary, for effective and comprehensive peer review evaluation. Immediately reports to the Coordinator, of Medical Staff Services, all information which is adverse to the application (i.e. credentialing issues, adverse letters, gaps on application, peer review recommendations, disciplinary actions, etc).
Responsible for the maintenance of accurate credential files on all medical staff and allied health professional members including current licensure, DEA, insurance, disciplinary proceedings and all correspondence relevant to each physician in order to maintain compliance with hospital, state, and other regulatory agencies. Ensures that all expiries are reviewed, obtained and managed on a monthly basis and updated prior to expiration, in accordance with the credentialing policy.
Assists in the coordination of orientation and EMR training for new appointments to the medical staff and allied health professional staff.
Tracks proctoring activities that support the professional practice evaluation process, including updating the credentialing database for tracking of information.
Tracks the informal and formal credentialing peer review and recommendation process, working closely with the appropriate section chiefs, department chairs, per established medical staff governing documents. Ensures that all quality review information is obtained and reviewed ongoing and prior to the reappointment process for assigned files; collects and reviews relevant statistical data from leadership of pertinent departments.
Processes temporary privileges in accordance with the governing documents.
Preparation and coordination of meetings, (including early morning and evenings); attends and prepares meeting packets and minutes as assigned, including follow up and preparation for reporting through the committee structure of the medical staff. Distributes appropriate correspondence utilizing standardized communication tools developed for the department and assures appropriate and timely follow up.
Prepares confidential reports for medical staff departments and committees.
Maintains medical staff database systems, identifying medical staff and allied health professional members, their current membership status, appointment data, clinical privileges, and certifications where applicable. Effective and timely entry of changes in the database and disseminates information as necessary.
Responsible for updating and distributing emergency room on call schedules in accordance with NCH medical staff governing documents, hospital policy, and EMTALA requirements.
Receives and addresses all medical staff inquires in person, writing, or via phone. Effectively interacts and communicates with hospital employees, medical staff members, patients, and visitors. Participates cooperatively in cross training-coverage initiatives in the department.
EDUCATION, EXPERIENCE AND QUALIFICATIONS
Minimum High School Diploma or GED required, Associate's Degree in preferred
Total of three years' experience in the medical services profession within the past five years (managed care and/or acute care facility) required.
Certified as a Certified Professional Credentialing Specialist (CPCS) by the National Association Medical Staff Services (NAMSS) within 6 years of employment.
Educational competencies must be met through the National Association Medical Staff Services Professionals (CPMSM or CPCS) with continuous certification required for this position
Complies with established policies, rules and regulations, bylaws, NCQA and TJC standards