CREDENTIALING COORD

What You Will Do:

POSITION SUMMARY
Under the direct supervision of the Credentialing Supervisor, performs credentialing and re-credentialing in accordance with 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:
1. Coordinates UMCAP 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.
2. Partners with Medical Staff Office personnel at all UMCAP 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.
3. 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.
4. 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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PRIMARY RESPONSIBILITIES
5. 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.
6. Maintains credential files in required format to meet requirements of Joint Commission, CMS and for legal presentations.
7. Is responsible for organization of, and completion of, specific projects as required to meet new regulatory requirements and/or system changes.
8. Maintains a working knowledge of Medical Staff Bylaws of client facilities.
9. Maintains credentialing compliance with the accrediting and regulatory agencies (

i.e., Joint Commission) while developing and maintaining a working knowledge of the regulations.
10. Is proactive regarding participation in available educational opportunities in the credentialing field.
11. 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:
1. Greets customers in courteous, friendly, respectful and professional manner at all times, including maintaining eyecontact when appropriate.

What You Need to Be Successful:

POSITION REQUIREMENTS:
Licensure/Certification/Registration
Required: Current Maryland [drop down menu] 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
Word: Intermediate Excel: Intermediate
PowerPoint: Basic Access:
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)
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Select highest applicable level: Exchange Information on Factual Matters
Bilingual: Required Preferred Language:
Other Language:
Problem Solving/Analytical Skills & Abilities (see attached explanation sheet):
Technical
Level of Supervision Required
Work Product is Reviewed Periodically
Contacts Inside & Outside Facility/Corporation (see attached explanation sheet)
Within/Outside Company with Tact and Discretion
Transportation (Work-related) (see attached explanation sheet)

Other:
Business Travel Outside of Region

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.