Credentialing Coordinator

Job Description

Job Description

POSITION OVERVIEW :

Under the supervision of the Credentialing Specialist, and / or designee, the Credentialing Coordinator will assist in organizing and maintaining all aspects of credentialing processes. The Coordinator is responsible for analyzing and evaluating provider credentials and maintaining files in accordance with accreditation and regulatory standards and according to the organization’s policy. Ensures appropriateness and accuracy of each document in credentialing file as it pertains to Licensed Independent Practitioners (LIP), Other Licensed Certified Practitioners (OLCP) and Other Clinical Staff (OCS).

KEY ESSENTIAL FUNCTIONS :

• Maintain communication with practitioners, Human Resources (HR), and program leaders to coordinate the receipt of information required all aspects of credentialing (i.e., initial, recredentialing, status changes, terminations and expiring credentials).
• Coordinate and pursue the receipt of expiring / expired credentials with attention to expirations dates and matters that require escalation via verbal and written communication.
• Perform primary and secondary source verifications of renewed licenses, registrations, and certifications.
• Identify discrepancies and resolves them quickly, ensuring credentialing compliance.
• Evaluate documents to determine if additional information is needed and follow up as appropriate to resolve.
• Responsible for assisting Credentialing Coordinator and Credentialing Manager with maintaining the credentialing process for all LIP, OLCP and OCS. Perform thorough review and analysis of providers’ applications and / or documents.
• Perform relevant primary source verifications as needed for all aspects of credentialing processes as needed, including, but not limited to, verification of licensure, registrations, certifications, Office of Professional Medical Conduct (OPMC), Office of Addiction Services and Supports (OASAS), National Practitioner Data Bank (NPDB), Office of Inspector General (OIG), Office of Medicaid Inspector General (OMIG), Opt Out, System for Award Management (SAM) and New York State Education Department (NYSED) Office of Professions.
• Track and pursue all annually required elements (i.e., talent reviews, job descriptions, competencies, health assessments, etc.)
• Collaborate the exchange of information with credentialing team to ensure accurate updating of credentialing rosters.
• Perform data entry, scanning and filing of all credentialing file elements.
• Identify issues that require additional investigation and evaluation such as validating discrepancies, adverse reports, negative reviews or ratings, and undisclosed matters that arise through the process. Ensure that those issues are brought up for review and discussion with the credentialing manager.
• Interface with internal and external customers on day-to-day credentialing and privileging issues as they arise.
• Generate re-appointment letters / forms as required for credentialing committee. Gather all relevant signatures needed (i.e., board representatives).
• Responsible for monthly monitoring to include K-checks, OPMC, NYSED and Social Security Death Master File (SSDMF) as applicable.
• Work collaboratively and professionally with Human Resources and department leaders as needed.
• Participate in all regulatory, accreditation and managed care audits involving credentialed providers.
• Provide timely responses to data requests.
• Maintain systematic efforts to maintain data integrity.
• Recommend and initiate ideas for process improvement.
• All other duties as assigned by Credentialing Manager or designee, as it pertains to credentialing.

REQUIREMENTS :

Minimum of one (1) year of experience in an administrative capacity in a healthcare or human resources environment preferred.

Extreme attention to detail;

SALARY RANGE :

The salary range for this position is $55,000.00 - $58,350.00.