Credentialing Coordinatior

The responsibilities of the Credentialing Coordinator encompass processing both credentialing and recredentialing applications for healthcare providers, maintaining both active and terminated files, and ensuring adherence to regulatory standards.

Our ideal candidates possess experience in healthcare credentialing and are well-versed in the standards set by the National Committee for Quality Assurance (NCQA), state regulations, and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

Ultimately, the Credentialing Coordinator's role is to guarantee that all medical staff members hold the necessary licensure, certification, and registration required to deliver medical care.

Essential Functions (Principal Duties and Job Responsibilities):

• Oversee the credentialing and crecredentialing processes for healthcare providers, ensuring all necessary documentation is collected and verified.
• Verify provider information, including education, training, licenses, certifications, and liability coverage.
• Maintain up-to-date credentialing databases and ensure timely renewal of licenses and certifications.
• Ensure compliance with regulatory standards, including those set by the National Committee for Quality Assurance (NCQA) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
• Serve as a point of contact for healthcare providers and internal staff regarding credentialing inquiries and processes.
• Prepare and maintain provider credentialing files and assist in presenting applications to the Credentialing Committee.
• Communicating with professionals to obtain necessary documentation
• Preparing and submitting credentialing applications and supporting documentation
• Researching and resolving credentialing issues
• Facilitating communication between the organization and credentialing agencies or bodies
• Organizing audits to ensure compliance with credentialing requirements
• Keeping informed about changes in regulations and standards related to credentialing

                                                                                                               

Knowledge, Skills and Abilities Required:

• Knowledge of medical credentialing and privileging procedures
• Proficiency in Microsoft Office and experience with Credentialing databases
• Excellent organizational skills and attention to detail
• Ability to handle sensitive information with discretion and confidentiality
• Understanding of healthcare regulations and medical terminology
• Understanding of relevant laws, regulations, and standards related to healthcare credentialing to ensure compliance.
• Ability to manage multiple tasks and deadlines to ensure the timely completion of credentialing processes.

  Education and Experience Required:

• Minimum of 5 years’ experience with Proven work experience as a Credentialing Coordinator or similar role in healthcare settings
• A background in medical staff services can be particularly beneficial.

• Bachelor’s degree in health care administration, business or another related field required.

Licensure, Certification or Registration Preferred:

• Certified Professional Credentialing Specialist (CPCS)