Coordinator, Credentialing

Credentialing Coordinator

Responsible for coordinating, monitoring, and maintaining the credentialing and re-credentialing process. Facilitates all aspects of credentialing, including appointment, reappointment, monitoring, and privileging for medical staff and allied health practitioners. Ensures compliance with accrediting and regulatory agencies in regards to credentialing while developing and maintaining a working knowledge of the statutes and laws. Responsible for the accuracy and integrity of the credentialing and clinical privileging database system and for ensuring the timeliness of credentialing / re-credentialing verification. Works under the supervision of the Medical Staff Services Director. Duties include the gathering, verification, and evaluation of confidential healthcare provider credentials, as well as contacting and following up with contracted network facilities to obtain documentation relevant to the credentialing process and data entry of all credentialing information provided by contracted facilities.

Responsibilities

• Broad base of understanding, integration, and application of BUHMCCredentialing policies and procedures.
• Accurate review of provider application or reappointment application packet for completeness and accuracy for the timely submission to the Credentialing Committee and subsequent venues for provider appointment to meet regulatory, insurance, and organizational requirements.
• Knowledge of and implementation of NCQA standards for participation and preparation of physician files for audits.
• Collects, verifies, and ascertains information needed for processing new applications, reappointments, temporary privileges, etc.
• Accurate input of initial and ongoing data elements recorded in the credentialing software system.
• Completion of Credentialing Checklist as operational control for internal credentialing processes.
• Creates and maintains accurate logs for mail, new applications, re-appointments, and system generated letters and tracks progress of same.
• Responds to inquiries for physician verification in an accurate and timely manner.
• Facilitation in the depth investigation and documentation required for remediation and management of "red flags issues for Credentialing Committee determination / appropriate follow through.
• Collection of required documentation with respect to the Delineation of Privileges for new appointments to the Medical Staff.
• Recognition of data verification triggers and conducts data validation as needed.
• Facilitates enrollment, communication, and reporting for the enrollment of providers with third party insurers.
• Recognition of data verification triggers; conducting data validationdata integrity efforts on as needed basis.
• Develop and distribute ad hoc report requests as requested.
• Self-directed, independent organization of work efforts with a high degree of accuracy.
• Demonstrates ability to prioritize work and meet deadlines.
• Participates in the Department's performance improvement activities.
• Maintains patient / employee confidentiality in the management of information.
• Perform other duties when necessary.

Qualifications

Education :

Experience :

Knowledge and Skills :

Licenses, Certifications :

Physical Requirements :

The salary range and / or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and can be modified in the future. When determining a team members base salary and / or rate, several factors may be considered as applicable (e.g., site, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget, and internal equity).

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The statements herein are intended to describe the general nature and level of work being performed by employees and are not to be construed as an exhaustive list of responsibilities, duties, and skills required of personnel so classified. Furthermore, they do not establish a contract for employment and are subject to change at the discretion of One Brooklyn Health (OBH).

OBH is an equal opportunity employer, it is our policy to provide equal opportunity to all employees and applicants for employment without regard to race, color, religion, national origin, marital status, military status, age, gender, sexual orientation, disability or handicap, or other characteristics protected by applicable federal, state, or local laws.