Credentialing Coordinator

Reporting directly to the Credentialing Manager, the Credentialing Coordinator assists in ensuring applicable providers are licensed and certified as mandated by state and federal regulations, and that notification to payers is timely and complete. Responsible for monitoring and maintaining the process for credentialing and re-credentialing providers.  Works with team members in the RCO to share pertinent information regarding providers credentialing status and communicates effectively. Collaborates with team members and uses applicable RCO tools and systems to ensure credentialing statuses remain current and accurate.

Hourly Rate: $23.34 - $24.40 (pay is commensurate with level of experience)

Essential Functions:

·        Works with the RCO and Credentialing team on various credentialing functions, regardless of payer. Follows determined processes to monitor and maintain systematic and timely credentialing.

·        Follows departmental standards and policies and procedures to ensure the accuracy of credentialing data in Professional Physical Therapy EMR database.

·        Leads, coordinates, monitors the review and analysis of practitioner applications, and accompanying documents, ensure applicant eligibility.

·        Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow-up.

·        Prepares credentialing files for completion.

·        Processes requests for privileges, ensuring compliance with criteria outlined in clinical privilege descriptions.

·        Assisting in the preparation for state and federal audits, responding to auditor’s inquiries and preparing responses to auditor’s findings.

·        Responds to inquiries from other healthcare organizations, interfaces with internal and external customers daily regarding credentialing and privileging issues and provides resolution as needed.

·        Assists with managed care delegated credentialing audits; conducts internal file audits.

·        Utilizes credentialing database, optimizing efficiency, performs query, report and document generation.

·        Monitors the initial, reappointment and expiring licenses for all medical staff, professional staff and delegated providers, ensuring compliance with regulatory bodies.

·        Participates in RCO and Credentialing meetings and ensures Credentialing functions are adhered to.

·        Behaves in a manner consistent with Professional’s mission, vision and values.

·        Attends training classes as directed and completes assigned training courses.

·        Maintains a working knowledge of HIPAA, OSHA, Risk Management and Compliance regulations.

·        Practices privacy protocols in accordance with Company policies and all applicable laws and regulations.

·        Performs other duties as assigned by the Credentialing Manager or RCO Management.

Requirements

·        Knowledge of/proficiency with Microsoft Office is required.

·        Knowledge of credentialing requirements strongly preferred.

·        Detail oriented and organized with the ability to work independently and in a group setting.

·        Strong research skills to gather pertinent information.

·        Ability to communicate effectively, both orally and in writing.

·        Ability to establish and maintain effective and cooperative working relationships with staff and others contacted in the course of work.