Credentialing Coordinator Job Description

Credentialing Coordinator Job Description

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Credentialing coordinator provides guidance, support, and education to Medical Staff leadership regarding practitioner credentialing and privileging processes and policies, including Bylaws, Rules and Regulations, and Allied Health Credentialing policies.

Credentialing Coordinator Duties & Responsibilities

To write an effective credentialing coordinator job description, begin by listing detailed duties, responsibilities and expectations. We have included credentialing coordinator job description templates that you can modify and use.

Sample responsibilities for this position include:

Ensures all credentialing system data and documentation comply with internal and external auditors of compliance and all applicable accreditation standards (The Joint Commission, CMS, NCQA, BORM)
Organize the processes for appointment, reappointment, privileging, system-wide database operations and other consolidation projects
Verify competence, medical and/or professional education, residency, internships, fellowships, additional formal training, relevant board certifications, healthcare affiliations, work history, military experiences, professional references, licensure and certifications, DEA certificates, Massachusetts Controlled Substance Registration (MCSR), malpractice coverage and privileges the applicant is requesting
Query the American Medical Association (AMA), CertiFacts and National Practitioner Data Bank (NPDB) as appropriat
Maintain the credentialing database assuring accuracy and completeness, generate reports and letters
Act as a liaison between the medical staff and other departments of the hospital and provide assistance in the coordination of the duties of the medical staff
Organize and maintain credentials files in the medical staff office and credentialing software
Facilitate medical staff committee meetings as requested, which includes committee notification, drafting agendas, taking and drafting minutes
Attend Credentials Committee meeting, take minutes and present completed files to the Committee for recommendation of appointments, re-appointments and privileges
Maintain a working knowledge of the Medical Staff Bylaws and applicable Hospital policies and procedure to ensure the medical staff’s compliance with stated parameters

Credentialing Coordinator Qualifications

Qualifications for a job description may include education, certification, and experience.

Licensing or Certifications for Credentialing Coordinator

List any licenses or certifications required by the position: CPCS, CPMSM, NAMSS, GOLD, ECFMG, DEA, BEP/WBE/MBE, NEMT, CPMSC, CMSC

Education for Credentialing Coordinator

Typically a job would require a certain level of education.

Employers hiring for the credentialing coordinator job most commonly would prefer for their future employee to have a relevant degree such as Collage and Associate Degree in Education, Associates, General Education, Medical, Business, Healthcare, Health, High School Education, Health Care, Health Administration

Skills for Credentialing Coordinator

Desired skills for credentialing coordinator include:

Medical terminology
Statutes and laws relating to credentialing
NCQA
Microsoft Office
Accreditation and certification procedures
Practitioner credentialing and primary source verification of medical/dental licensure
Privileging
Related credentialing
Requirements and hospital operations
Title 22

Desired experience for credentialing coordinator includes:

Manage both the Ongoing Professional Practice Evaluation (OPPE) and Focused Professional Practice Evaluation for the medical staff and allied health professionals
Performing primary source verification on required elements and in accordance with the organization's policies and procedures
Verifying New York State OPMC and Medicare / Medicaid for any current sanctions, restrictions on licensure and/or limitations on the scope of practice on all credentialed providers in interim credentialing periods
Performing other related tasks as directed by the Associate Executive Director of Quality Management, the Credentialing Director and the Credentialing Team Lead
Perform primary source verification on required elements
Complete data entry and upkeep of provider information in the credentialing database

Credentialing Coordinator Examples

1

Credentialing Coordinator Job Description

Job Description Example
Our company is hiring for a credentialing coordinator. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for credentialing coordinator
  • Create, copy, file, and maintain all relevant documentation into provider credentialing folder
  • Perform primary source verification on required elements and in accordance with policies and procedures
  • Oversee data entry and upkeep of provider information in the credentialing database
  • Verify competence, medical and/or professional education, residency, internships, fellowships, additional formal training, relevant board certifications, healthcare affiliations, work history, military experiences, professional references, licensure, certifications, malpractice coverage and privileges the applicant is requesting
  • Query the American Medical Association (AMA), CertiFacts and National Practitioner Data Bank (NPDB) as appropriate
  • Manage monthly expirables
  • Attends Credentials Committee meeting, takes minutes and presents completed files to the Committee for recommendation of appointments, reappointments and change in privilege requests
  • Manage both the Focused Professional Practice Evaluation (FPPE) and Ongoing Professional Practice Evaluation (OPPE) for the medical staff and allied health professionals
  • Assists the PM&R physician advisor, manager and divisions regarding active medical staff appointments for initial appointments and reappointments
  • Maintain and modify departmental database, integrating appointment, credentials, historical information, for all PM&R faculty and others
Qualifications for credentialing coordinator
  • Knowledge of medical credentialing, billing/collection practices
  • Knowledge of insurance company operating procedures and practices
  • Skill with computer applications
  • Ability to courteously work with Physicians, hospital staff, insurance company representatives, coworkers and others
  • Ability to interact professionally and collegially with referral sources (hospital & nursing home staff, physicians, social service workers, ), state contract officers, and coworkers
  • Obtains credentialing information on all new CCF medical staff members
2

Credentialing Coordinator Job Description

Job Description Example
Our company is looking for a credentialing coordinator. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for credentialing coordinator
  • Adhering to established credentialing guidelines completes in-depth review and analysis of practitioner’s application and accompanying documents ensuring applicant meets facility guidelines and eligibility
  • Attend and participate in all team related meetings
  • Under direct supervision learns the credentialing and verification process
  • Attend and participate in all team related meetings, work diligently to support company-wide and team goals
  • Complete physician applications for the state medical licenses and hospital privileges
  • Manage radiologist credentialing according to department policy and procedures
  • Maintain physicians’ license expirations
  • Conduct verification of credentialing elements through the use of system resources and approved departmental tools and document status within credentialing database(s)
  • Files all information promptly
  • Works with physicians to complete and obtain documentation
Qualifications for credentialing coordinator
  • Associate’s degree or equivalent preferred but not required
  • Requires 1 -3 three years of experience in health care credentialing/ verification
  • Excellent computer skills including Excel, Word, Database maintenance, and Internet use
  • Minimum of one year credentialing experience required or equivalent combination of education and experience
  • Good communication skills – written, telephone, and email
  • Analyzes errors and traces back to the root cause using the raw data in the appropriate file or database as it relates to initial appointment and reappointment files, expirables
3

Credentialing Coordinator Job Description

Job Description Example
Our growing company is searching for experienced candidates for the position of credentialing coordinator. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for credentialing coordinator
  • Ability to compile and maintain current and accurate data for all providers
  • Ability to complete provider credentialing and recredentialing applications
  • Ability to maintain copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers
  • Knowledge of initiating and completing provider CAQH profiles
  • Knowledge of current managed care plans and government requirements for credentialing providers
  • Ensures practice addresses are current with health plans, agencies and other entities
  • Tracks license, DEA and professional liability expirations, Nurse protocols and certifications for providers
  • Prepares credentials file for completion and presentation to Central Verification Office, ensuring file completion within time periods specified
  • Request facility site reviews from appropriate source
  • Responsible for the generating, mailing, tracking, and subsequent processing of provider re-credentialing applications
Qualifications for credentialing coordinator
  • Must be able to communicate professionally with all providers
  • Prior credentialing experience
  • Ensures that appointments and reappointments to the Medical Staff and Advanced Practice Professionals (APP) are processed efficiently and in accordance with the Medical Staff Bylaws, APP Guidelines, and specific policies and procedures of the Medical Staff Credentialing Process
  • Able to withstand intense interpersonal interaction
  • Confidentiality and compliance with healthcare regulations affecting special privileges afforded the Medical Staff with regards to the protected and confidential nature of Medical Staff Proceedings
  • After reapplication is received ensure it is complete
4

Credentialing Coordinator Job Description

Job Description Example
Our growing company is looking to fill the role of credentialing coordinator. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for credentialing coordinator
  • Prepares and distributes correspondence by Medical Board, Medical Staff Officers and Administration
  • Ensures credentialing records are prepared for audits performed by managed care companies, Department of Health, Joint Commission, healthcare facilities, legal entities
  • Creates credential files from initial information received from recruiting
  • Researches and obtains verification of physicians' medical experience, professional references, state licensure, DEA, state narcotics, Evaluates data and determines suitability of match with EmCare clients
  • Networks and coordinates the sharing, receipt, and/or update of information among various internal departments
  • Coordinates with state licensure boards and physicians to obtain applications, documentation, and data necessary to obtain state licenses
  • Collects and maintains all pertinent information from the provider
  • Analyzes provider files for completeness, accuracy, consistency, gaps in work history, relevant references, Identifies issues and initiates further data collection as needed
  • Updates and maintains physician CVs
  • Completes initial and reappointments applications on all physician for local and outreach hospitals
Qualifications for credentialing coordinator
  • High school education, including one or two years additional in Business, English, Liberal Arts, or an aptitude in any of these fields
  • Minimum of two to three years of credentialing experience at a health plan, medical group or hospital strongly desired or transferable job skills in government provider enrollment
  • Must be comfortable speaking with all levels of management
  • Must have an Associates degree in a health or business related field
  • Requires training and proficiency in the use of Microsoft Word and report writing computer programs
  • Prior experience in medical staff credentialing desirable
5

Credentialing Coordinator Job Description

Job Description Example
Our company is growing rapidly and is searching for experienced candidates for the position of credentialing coordinator. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for credentialing coordinator
  • Executes the Medical Staff and Allied Health privileging process in accordance with the MHMH Medical Staff Bylaws, Rules and Regulations, policies and procedures and in accordance with guidelines of all Regulatory bodies including the TJC and the appropriate states
  • Completes initial credentialing and re-credentialing applications on all physicians for managed care companies
  • Ensures all physicians’ licensure, DEA and DPS certificates are current
  • Ensures all physician extenders’ licensure and certificates are current
  • Obtains credentials for all physician extenders with each hospital at which their sponsors have privileges
  • Ensures CME hours meet licensure requirements
  • Assists Business Office staff as needed
  • Processes provider applications and re-applications
  • Advanced computer skills (MS Office Suite’s Word, Access, Excel, & Outlook
  • Assists in developing and implementing short and long-term work plans and objectives
Qualifications for credentialing coordinator
  • Bachelor's Degree preferred or at least (3) years of experience directly related to hospital credentialing
  • Excellent telephone and organizational skills are essential
  • Certification as a Certified Professional Credentialing Specialist (CPCS by the National Association of Medical Staff Services (NAMSS) desirable
  • Requires initiative and organizational ability
  • Uses good judgment and critical thinking skills
  • Oversees the process to prepare Clinic and Center Managers to onboard new physicians

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