Credentialing Coordinator

This is a fully remote position, open to applicants in New York.

📋 Description

• Engages in departmental initiatives to guarantee quality in the execution, upkeep, and communication of the medical and allied health professional staff credentialing, privileging, and primary source verification processes.

• Acts as a departmental resource and collaborates with team members to enhance practitioner quality and ensure patient safety within the facility.

• Assesses practitioner eligibility for membership and participation.

• Reviews applications and accompanying documents for accuracy and completeness, updating practitioners on their application status, including any requirements for additional information or corrections.

• Gathers, investigates, and evaluates data from primary sources to ensure adherence to accreditation and regulatory standards, validating the accuracy of applications for one or more decision-making entities.

• Identifies, investigates, and verifies discrepancies and adverse information during the application process, ensuring that review and approval bodies possess the necessary information for informed credentialing decisions.

• Manages requests for privileges when appropriate, ensuring compliance with criteria specified in clinical privilege descriptions.

• Oversees the initial and reappointment processes for all Medical and Allied Health Professional staff as required to ensure timely processing of appointments in accordance with regulatory requirements.

• Tracks the status of completed files in departmental and committee reviews until final approval to ensure adherence to regulatory standards.

• Keeps track of personal performance metrics concerning accuracy and productivity, communicating with management regarding any questions, concerns, or the need for additional training.

• Regularly reviews performance metrics and goals with auditors and management.

• Coordinates and collaborates with Credentialing Managers and staff.

• Works with various departments and key stakeholders to ensure compliance with all policies and standards.

• Updates providers and various departmental representatives, clients, and/or affiliates on the status of applicant files.

• Acts as a resource for departments and clients regarding medical staff bylaws, policies, and procedures.

⛳️ Requirements

• An associate's degree in business or a healthcare-related field, along with 2 years of medical administrative experience, is required.

• Preferred: 1 year of experience in medical credentialing and/or payer enrollment.

• Required: Fluent English language skills (both oral and written).

• Required: Proficiency in MS Office applications (e.g., Word, Excel, and PowerPoint), email, and internet usage.

• Preferred: Knowledge and experience with Joint Commission, CMS, and NCQA Regulations pertaining to medical staff services and Commercial Payers Credentialing.

• Preferred: Familiarity with database applications.

• Preferred: Outstanding interpersonal and communication skills.

• Preferred: Ability to cultivate and sustain relationships with various key stakeholders across the organization.

🏝️ Benefits

• Competitive salary and comprehensive benefits package.

• Opportunities for professional development and career advancement.

• Supportive and collaborative work environment.

• Employee wellness programs.