CREDENTIALING COORD

What You Will Do:

POSITION SUMMARY

Under the direct supervision of the Credentialing Manager, performs credentialing and recredentialing in accordance with AAHC, TJC, CMS and Medical Staff requirements for the purpose of Medical/AHP Staff membership and Privileges. The Credentialing Coordinator manages practitioner files working cooperatively with practitioners, internal departments and contract groups to ensure the seamless and timely flow of credentials information in order to meet appointment ad reappointment deadlines. Individual must demonstrate initiative, resourcefulness and problem solving skills in executing functions to ensure the orderly flow of business.

This position description indicates in general the nature and levels of work, knowledge, skills, abilities and other essential functions expected of an incumbent. It is not an exhaustive comprehensive listing of activities, duties or responsibilities required of an incumbent. An incumbent may be asked to perform other duties as required.

PRIMARY RESPONSIBILITIES

Principal Duties:

• Coordinates DHS Medical/AHP Staff credentialing (initial and reappointment applications) - from receipt, to presentation to facilities for review/approval - verifying all background information, performing gap analysis, performing required primary source verifications of information on practitioner (verifying education, training, experience and competence), analyzing information obtained to ensure that membership and privilege requirements are met, within established timeframes.

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  Partners with Medical Staff Office personnel at all Dimensions facilities to ensure an integrated, timely and consistent product, with the goal of ensuring regulatory and Bylaws requirements are met, and that practitioners do not have a gap in privileges.

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  Collaborates with practitioners and/or contract and practice group contacts regarding status of applications, credentialing issues, pending expirations or expirations of required licensure and certifications, or questions and to ensure timely credentialing.

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  Collects and analyzes documents, data and verifications, and prepares reports by monitoring data published by Maryland licensing boards, FSMB, OIG and NPDB and other applicable sources, screening for any adverse actions.

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  Manages continuous credentialing process by collecting and analyzing documents and performing primary source verifications of medical malpractice insurance, licenses, prescriptive licenses, and other required certifications for membership and specific privileges.

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  Maintains credential files in required format to meet requirements of Joint Commission, CMS and for legal presentations.

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  Is responsible for organization of, and completion of, specific projects as required to meet new regulatory requirements and/or system changes.

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  Maintains a working knowledge of Medical Staff Bylaws of client facilities.

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  Maintains credentialing compliance with the accrediting and regulatory agencies (i.e., Joint Commission) while developing and maintaining a working knowledge of the regulations.

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  Is proactive regarding participation in available educational opportunities in the credentialing field.

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  Develops and maintains personal work processes that are cohesive with credentialing objectives and goal dates, and which can seamlessly be transferred to another coordinator if required.

Customer Service:

• Greets customers in courteous, friendly, respectful and professional manner at all times, including maintaining eye contact when appropriate.
• Follows communication protocols to both internal and external customers, including introducing him/herself with job title and experience, asking open ended questions, such as “How may I be of help to you?” using the customer’s name as soon as it is learned.
• Responds promptly and appropriately to customer questions/concerns/complaints and attempts immediate resolution.
• Keeps customer’s information confidential, including public places such as elevators or the cafeteria.
• Provides assistance and offers help immediately, including finding someone else to meet the request, if unable to do so him/herself. Introduce other staff to customers when a hand-off occurs and explain that the person will provide excellent service.

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  Demonstrates commitment to excellent service recovery when a customer’s expectations have not been met.

Commitment to Co-Workers:

• Offers assistance to colleagues and other departments when needed.
• Takes responsibility for solving problems regardless of origin; completes assignments, and respects deadlines.
• Resolves conflict directly with colleagues and seeks assistance from others if the issue cannot be resolved. Refrains from criticism in public.
• Mindful and respectful of others’ time and schedules. Attends meetings on time and communicates any absences.
• Provides co-workers with a status report for continuity of workflow when planning to be out of the office, off the unit, or away from the department

What You Need to Be Successful:

POSITION REQUIREMENTS:
Licensure/Certification/Registration
Required: in good standing as a .
Preferred:
Other:
Life Support Certification: (Check all that apply)
Basic Life Support – Health Care Provider (BLS-HCP) Advanced Cardiac Life Support (ACLS)
Pediatric Advanced Life Support (PALS) Neonatal Resuscitation Program (NRP)
Education/Knowledge (see attached explanation sheet)
Attained Level: Entry level
Preferred: Associates’ Degree in Healthcare Administration or related field.
Completed Course Work/Program: High School Diploma
Applicable Experience
Experience (years): Required: 1 year Preferred: 3 or more years
Experience (describe required & preferred): One year of experience in a healthcare setting working with physicians, mid-level providers and office staff addressing coding and billing matters.
Technical/Clinical Skills
Microsoft Office Suite Skill Level (see attached explanation sheet)
Word: Intermediate Excel: Intermediate
PowerPoint: Basic Access: [drop down menu]
Working knowledge of ICD-9 (Medical Coding)
Basic knowledge and working experience with Medical Terminology
Standard Office Equipment (list):
Medical Equipment (list):
Other:
Communication Skills & Abilities (see attached explanation sheet)

We are an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.