Credentialing Coordinator

The Credentialing Coordinator is responsible for all aspects of the initial credentialing, re-credentialing and privileging functions for all clinicians on medical and allied health staff at the VCU Health System Hospitals.

The Coordinator includes interacting with clinicians to obtain applications and pertinent documents evaluating data for accuracy and completeness, monitoring receipt and follow up responses ensuring timely and efficient processing.

This position notifies supervisor Director of any adverse, incomplete or questionable data. This job works independently and is able to assess a situation, consider alternatives and choose the appropriate course of action.

This job demonstrates sound organizational ability and effectively sets priorities. This job must be able to maintain strict confidentiality and professional discretion.

This job ensures compliance with hospital bylaws, and with local, state and federal requirements. This job provides assistance to the Director in development, plans, organization and control of the operation of the Medical Staff Office in order to meet the mission and goals of the hospital and the requirements of the Medical Staff Bylaws, JCAHO, NCQA Standards and other applicable federal, state and local regulatory and / or accrediting agencies.

This job attends medical staff committee meetings as directed. Interacts and provides support services to medical staff officers, departments and chairs as assigned.

Licensure, Certification, or Registration Requirements for Hire :

Certified Provider Credentialing Specialist (CPCS) preferred

Licensure, Certification, or Registration Requirements for continued employment :

Certified Provider Credentialing Specialist (CPCS) preferred

Experience REQUIRED :

Minimum of three (3) years previous credentialing and medical terminology experience in a hospital or managed care credentialing setting

Previous experience using a personal computer and various applications, including Microsoft Office Access, Word, and Excel and credentialing software

Experience PREFERRED :

Five (5) years of previous experience in credentialing in a health care environment

Previous experience with the application of JCAHO, URAC and NCQA guidelines

Certified Professional in Medical Services Management (CPMSM)

Education / training REQUIRED :

Associates or Bachelors degree or experience in lieu.

Education / training PREFERRED : Associates or Bachelors Degree in Business, Healthcare or closely related field

Independent action(s) required :

Expresses ideas and exchanges information clearly and concisely.

Demonstrates the ability to prioritize work assignments effectively and efficiently within the scope of the employee’s responsibility.

Effective development of relationships with other members of the team (i.e. non-clinical personnel, etc.)

Highly motivated individual with independent work habits.

Organizational skills, proficiency in MS Office Access, Word, and Excel and credentialing software, and numerous hospital databases with extreme attention to detail are critical indicators for success in this role.

Ability to multi-task in stressful and limited time constrained environment.

Must possess knowledge of local, federal and state laws and regulations and JCAHO standards related to position’s chief objective and demonstrate aptitude for compliance with VCUHS policies, procedures, and customer service philosophy.

Supervisory responsibilities (if applicable) : N / A

Additional position requirements : N / A

Age Specific groups served : N / A

Physical Requirements (includes use of assistance devices as appropriate) :

Physical : Lifting 20-50 lbs.

Activities : Prolonged standing, Frequent bending, Walking (distance), Reaching (overhead, extensive, repetitive)

Mental / Sensory : Strong recall, Reasoning, Problem solving, Hearing, Speak clearly, Write legibly, Reading, Logical thinking

Emotional : Fast pace environment, Steady pace, Able to handle multiple priorities, Frequent and intense customer interactions, Able to adapt to frequent change

EEO Employer / Disabled / Protected Veteran / 41 CFR 60-1.4.