Credentialing Coordinator, PBO-Credentialing

Job Description

Performs credentialing duties and collaborates with physician offices, hospital medical staff committees, and the Health Alliance Central Verification Office to complete data collection and documentation for the medical staff and allied health professionals in the credentialing process. Responds to requests for verification and information from internal and external customers. Coordinates and prepares documents for Credentials Committee and other medical staff committees as assigned. Maintains the physician credential/privilege database and files.

Responsibilities

Assembles, Compiles, and Presents Documentation to support accurate and timely granting of initial appointment and reappointment to the Medical Staff /Allied Health Staff. Uses information gathered from internal and external sources. Follows organizational and regulatory requirements. Identifies potential problems. Proactively assists in problem resolution. Creates and Updates Databases and Provider-specific Credentialing Files in order to assure compliant, accurate and up-to-date records. - 20% Maintains physician information in Cactus, Last Word, and other applicable data systems. Maintains TB and other health status records. Provides reports to internal and external customers. Ensures integrity of office files by performing peer review on internal files. Effectively Communicates and assists internal and external customers. Researches general medical staff issues. Works collaboratively with Central Verification Office, Physician Offices, Patient Care Services, Medical Staff leaders, and Hospital Management/Administration. Responds in timely manner. Executes required actions. Identifies potential problems. Proactively assists in problem resolution. Supports Physician /Allied Health Committees. Prepares agendas and rosters for monthly meetings of Credentials/ Allied Health Committee. Records minutes and prepares, distributes summary of meeting. Maintains documentation as required. Prepares timely and accurate reports for Medical Executive Committee as assigned. Provides overview to new physician members of Credentials Committee. Maintains organized Medical Staff Office. Performs oversight functions including training and managing performance of credentialing specialist, clerical, and volunteer staff. Maintains clean and organized work environment. Enforces policies and procedures. Assists director with business functions as assigned. Assists director with performance improvement activities, Joint Commission accreditation preparation, and other tasks as assigned.

Qualifications

Preferred: Bachelor degree. | CPCS and/or CPMSM Certification by National Association of Medical Staff Services (NAMSS) preferred. CPCS (Certified Provider Credentialing Specialist). CPMSM (Certified Professional in Medical Staff Management). | 1-3 yrs experience with physician credentialing, with knowledge of medical staff accreditation standards. Credentialing experience in hospital, physician group, or managed care setting. 1-2 years experience in hospital-based credentialing preferred.