Credentialing Coordinator III

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

📋 Description

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

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

• Assesses practitioner eligibility for membership and participation.

• Reviews applications and supporting documents for precision and completeness, informing practitioners about their application status, including any additional information or corrections needed.

• Gathers, investigates, and assesses information from primary sources to confirm compliance with accreditation and regulatory standards, validating the accuracy of applications for various decision-making bodies.

• Identifies, examines, and verifies discrepancies and negative information obtained during the application process, ensuring that review and approval bodies have the necessary information to make informed credentialing decisions.

• Manages requests for privileges when applicable, ensuring adherence to criteria specified in clinical privilege descriptions.

• Oversees the initial and reappointment process for all Medical and Allied Health Professional staff as required, ensuring that appointments are processed within the requested or mandatory timeframes.

• Communicates the status of applicant files to providers and various department representatives, clients, and/or affiliates, coordinating efforts to gather necessary information and documentation.

⛳️ Requirements

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

• At least 1 year of experience in medical credentialing and/or payer enrollment is preferred.

• Proficient English language skills (both oral and written) are mandatory.

• Expertise in MS Office (including Word, Excel, and PowerPoint), email, and internet usage is required.

• Familiarity with Joint Commission, CMS, and NCQA regulations pertaining to medical staff services and Commercial Payers Credentialing is preferred.

• Knowledge of and experience with database applications is preferred.

🏝️ Benefits

• N/A