The Credentialing Coordinator is responsible for supporting the credentialing program which includes but not limited to ensuring the quality of credentialing and re-credentialing files of employed providers in accordance with NCQA guidelines. The Credentialing Coordinator is also responsible for maintaining internal quality standards, supporting the Credentialing Committee program and coordinating certain compliance activities. The Credentialing Coordinator will assist in the process of intake, tracking and reporting injury care patient complaints. In addition, Credentialing Coordinator will assist in network and provider relations activities that support the goals of creating efficiencies and streamlining workflow processes in the department. The Credentialing Coordinator will report to the Senior Credentialing Specialist.
•The credentialing coordinator is responsible for the delegated rosters and serves as the liaison between Nova Medical Centers and external contracted networks and credentialing entities.
•Prepare and maintain credentialing files and reports including maintenance of the credentialing software, provider rosters and spreadsheets to comply with delegation rules and requirements.
•Ensures the timely notification of provider changes to medical staff and other inter-department stakeholders
•Ensures timely and professional communication with providers, documents interactions and follow ups as required to ensure timely file completion
•Ensures monthly maintenance of files to ensure compliance, i.e. licenses, DEA, malpractice
•Tracks and monitors non-responsive providers.
•Maintains confidentiality and security of provider files.
•Fields, logs and tracks injury care patient complaints and reports them to committee for review.
•Completes assigned projects within agreed upon timeframes
•Ensures files ready for committee review and meet accuracy for completeness
•Assists the Senior Credentialing Specialist in auditing credentialing and re-credentialing files for committee presentation.
•Ensures all outstanding issues are resolved prior to committee review/Obtains information from practitioners tabled/pended from previous meetings
•Knowledge and experience with HIPAA Compliance
•Assists in updating and maintaining the Prescriptive Supervision Schedule for Senior Credentialing Specialist
•Coordinates the interdepartmental credentialing committee meetings by contacting the committee members and setting up the time, date and place of meeting.
•Prepares and collates committee packets as outlined in the committee agenda
•Attends committee meetings as assigned by the Senior Credentialing Specialist
•All other job-related duties as it relates to the job function or as delegated by the management team.
Preferred 2-3 years of experience Credentialing experience in physician Credentialing department