Credentialing Coordinator Resume Samples

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LM
L MacGyver
Luis
MacGyver
58198 Gusikowski Ridge
Houston
TX
+1 (555) 325 8869
58198 Gusikowski Ridge
Houston
TX
Phone
p +1 (555) 325 8869
Experience Experience
Los Angeles, CA
Credentialing Coordinator
Los Angeles, CA
Zieme, Terry and Hoeger
Los Angeles, CA
Credentialing Coordinator
  • Establishes productive relationships with medical providers and office staff to facilitate prompt integration into company network
  • Generates and manages various reports for management, implementing best practices and working on projects as assigned
  • Assists Manager in development and fulfillment of short/long term departmental goals
  • Assists Manager in file review for annual audits by Manage Care Plans
  • Performs primary source verification, records information received and provides follow up as necessary according to established policies and procedures
  • Make attempts on the follow-up for re-credentialing applications and requested documents and notify local Provider Relations Representative to assist
  • Establish and maintain positive & effective communication with providers, management, clients, and other identified stakeholders
Dallas, TX
Credentialing Coordinator GI Associates
Dallas, TX
Lueilwitz Group
Dallas, TX
Credentialing Coordinator GI Associates
  • Work collaboratively with Division’s research management team to address research credentialing issues
  • Arrange for interviews of faculty applicants, collect letters of reference, and assist with processing of travel reimbursement
  • Facilitate, oversee, and ensure timely completion of the appointment, reappointment, promotion and new hire process for professional and non-professional staff in the Gastroenterology Division
  • Facilitate, process, and maintain records for annual employee performance evaluations (ie sends forms to managers and notifies them of upcoming evals due, provides copy to Administrative Director of Research for processing, and sends original to HR records)
  • Assist Chief and Clinical Chief with drafting and formatting of formal written correspondence including letters of support and letters of recommendation for research collaborators, pre- and post-doctoral trainees, and faculty appointments and promotions
  • Coordinate Fellowship application and interviewing process; maintain ACGME accreditation; provide ongoing support to Fellows
  • Coordinate with Partners International Office to ensure timely submission and processing of visas and immigration documentation for non-U.S. citizens
present
Dallas, TX
Senior Credentialing Coordinator
Dallas, TX
Schuster, Hilpert and Schumm
present
Dallas, TX
Senior Credentialing Coordinator
present
  • Manages all aspects of appointments and medical staff credentialing for faculty, fellows, medical staff, housestaff and others
  • Create credential-related reports for managers, chairman, administrator, departmental credentials personnel, committee chairs, division managers, division chiefs, search committees, etc
  • Educates and informs faculty and division personnel about credentialing policies and procedures
  • Create manuals, flow charts and other educational material related to the credentialing effort in the department
  • Partners with the Central Credentialing Office (CCO), Medical Review Staff, and JHU affiliates, such as, JHBMC, KKI, JHHS, and JHU to facilitate the credentialing process for medical staff including, faculty, fellows, medical staff, housestaff, and others
  • Oversees the maintenance of existing database, automate the credentialing and medical staff process for the department
  • May be responsible for creating and implementing a Share Point site with updated credentialing and medical staff information. (Also, may use other methods of maintaining information)
Education Education
Bachelor’s Degree in Related Field Preferred
Bachelor’s Degree in Related Field Preferred
North Carolina State University
Bachelor’s Degree in Related Field Preferred
Skills Skills
  • Detail oriented with the ability to follow through with details accurately and consistently
  • Excellent interpersonal skills including the ability to interact effectively and professionally with individuals at all levels; both internal and external
  • Problem solving skills with the ability to look for root causes and implementable, workable solutions
  • Self-motivated with strong organizational skills and superior attention to detail
  • Good speaking ability, judgment, and initiative
  • Strong attention to detail
  • Knowledge of office administration procedures with the ability to operate most standard office equipment
  • Excellent interpersonal skills and commitment to quality improvement
  • Ability to work professionally with sensitive, proprietary data & information while maintaining confidentiality
  • Strong organizational skills and a high level of attention to detail
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15 Credentialing Coordinator resume templates

1

Credentialing Coordinator Resume Examples & Samples

  • Ten years’ experience as a medical staff services professional
  • Knowledge of Joint Commission standards, Title 22, and CMS regulations pertaining to the organized medical staff
  • Knowledge of medical staff principles, practices, quality assessment, performance improvement functions, and legal concepts related to the organized medical staff
  • Valid CPMSM or CPCS certification by the National Association of Medical Staff Services
2

Credentialing Coordinator Resume Examples & Samples

  • 1+ year of previous experience with provider Credentialing processes and procedures
  • Microsoft Office/Suite proficient
  • Knowledge of NYCHHC credentialing policies and procedures
  • Knowledge of CACTUS
3

Credentialing Coordinator Resume Examples & Samples

  • Five years’ experience as a credentialing professional preferred
  • Hospital or multi-entity credentialing experience preferred
  • Knowledge of Joint Commission, DNV, and NCQA standards, Title 22, and CMS regulations pertaining to the organized medical staff
  • If not certified, must achieve certification within two years
4

Credentialing Coordinator Resume Examples & Samples

  • Initiate verification processes of OU MEDICAL CENTER Medical Staff initial and reappointment applications to include standardized, cost-effective verification that comply with JCAHO and other regulatory agency standards
  • Provides accurate medical staff databases to the facility as well as other facility specific reports upon request
  • Maintains current copy of all medical staff bylaws, rules and regulations and is knowledgeable of hospital bylaws and rules and regulations relating to credentialing processes
  • Establishes procedural criteria according to bylaws, rules and regulations; and ensures requirements for staff privileges are maintained
  • Experience:Three (3) years of administrative technical clerical experience OR An equivalent
5

Senior Credentialing Coordinator Resume Examples & Samples

  • Manages all aspects of appointments and medical staff credentialing for faculty, fellows, medical staff, housestaff and others
  • Develop, implement and maintain appropriate departmental policies and procedures related to executing the credentialing processes in accordance with JHH and JHU School of Medicine policies, government regulations and JCAHO guidelines
  • Create credential-related reports for managers, chairman, administrator, departmental credentials personnel, committee chairs, division managers, division chiefs, search committees, etc
  • Educates and informs faculty and division personnel about credentialing policies and procedures
  • Create manuals, flow charts and other educational material related to the credentialing effort in the department
  • Partners with the Central Credentialing Office (CCO), Medical Review Staff, and JHU affiliates, such as, JHBMC, KKI, JHHS, and JHU to facilitate the credentialing process for medical staff including, faculty, fellows, medical staff, housestaff, and others
  • Oversees the maintenance of existing database, automate the credentialing and medical staff process for the department
  • May be responsible for creating and implementing a Share Point site with updated credentialing and medical staff information. (Also, may use other methods of maintaining information)
  • Oversee the reappointment and end-provisional process for medical staff
  • Assists the PM&R physician advisor, manager and divisions regarding active medical staff appointments for initial appointments and reappointments. Coordinates all documentation and agenda for the committee as needed
  • Maintain and modify departmental database, integrating appointment, credentials, historical information, etc. for all PM&R faculty and others
  • Create and manage an electronic faculty filing system
  • Create and maintain tracking processes for appointments, promotions and medical staff appointments
  • Serve as liaison between the Department and JHH Medical Staff Administration, the School of Medicine Dean’s Office and the JHU Office of International Student, Faculty and Staff Services
  • Provide information to the Departmental Billing Office about prospective appointments to the medical staff
  • Partner with Sr. leadership to track competencies, licensures, etc. to comply with JCRB. Maintain/modify personnel files (paper and electronic) to comply with Joint Commission Review Board
  • Ability to be extremely well organized, with careful attention to detail and follow up
  • Strong oral and written communication skills needed
  • Strong interpersonal skills with the ability to interact with all levels of faculty and staff needed
  • Knowledge of computer programming, particularly in the development and implementation of databases needed
  • Ability to manage a number of demanding projects simultaneously
  • Word, Excel, Databases, and Power Point skills needed
6

Credentialing Coordinator Resume Examples & Samples

  • Meeting with Chief Medical Officer/Medical Director to review cases for approval
  • Coordinating and leading Monthly Credentialing Committee
  • Writing detailed Minutes
  • Write/revise policy, procedures, guidelines and auditing tools
  • Presenting Credentialing Files to Committee for discussion and approval
  • Overseeing delegated credentialing functions to subcontracted providers
  • Completing quarterly report for AHCCCS deliverable
  • Conducting on-site assessments as part of the credentialing process
  • Organizational and corporate structures and management practices and procedures typically utilized in facilities that serve individuals with developmental disabilities
  • Oral and written communication and documentation skills
  • Facilitating meetings
  • Credentialing requirements, Center for Medicare and Medicaid Services grants requirements, and federal and state laws
  • Problem solves issues with obtaining required documents
  • The candidate will possess the Certified Professional in Healthcare Quality (CPHQ) certification
7

Credentialing Coordinator Resume Examples & Samples

  • Coordinates the development and maintenance of systems and procedures within the Credentialing Office to ensure timely, thorough and accurate credentials verification
  • Coordinates appointment and reappointment process for all CCF- professional staff and Allied Health Professionals
  • Meets credentialing/re-credentialing deadlines
  • Maintains and tracks professional license renewals
  • Coordinates and processes all application for reappointment on a timely manner as required by JCAHO and NCQA
  • Reviews and processes all request for temporary and on-case privileges to physicians
  • Coordinates all Focused Professional Performance Evaluations (FPPE) for medical staff and AHPs
  • Assists in maintaining peer review files for all physician and allied health professionals credentialing files in an Organizational and consistent manner
  • Assists with all components of the preliminary primary source verification process
  • Develops and maintains effective lines of communication necessary for CCF's day to day credentialing operations
  • Ensures CCF's compliance with State, National, JCAHO, NCQA and URAC credentialing requirements
  • Obtains credentialing information on all new CCF medical staff members. Informs OPSA, Department/Division Chairs of highly sensitive, sometimes adverse, information uncovered in the credentialing/re-credentialing process
  • Adheres to credentialing timeframes and deadlines dictated by regulatory bodies so that provider files stay in compliance at all times
  • Assists Manager in file review for annual audits by Manage Care Plans
  • Develops and implements ways in which to improve and more efficiently accomplish compliance per NCQA per the delegated plans
  • Assists with the departmental orientation of new Medical Staff Members, including maintaining and updating Physician Orientations packets
  • Prepares and mails all application for privileges and follow-up phone calls to doctor offices to expedite credentialing
  • Performs all Quarterly License and monthly OIG/Medicare Sanctions and EPLS required checks
  • Maintains binder with Physician Acknowledgment Statements to meet FMQAI requirements
  • Tracks and maintains all License, DEA, Malpractice Insurance, and Board Certification expiration dates
  • Updates revised and current delineation of privilege forms for physician
  • Assists with Annual Staff Meeting preparation
  • Distributes, collects, and tabulates all Medical Staff voting items
  • Maintains all demographic information on all Medical Staff Rosters
  • Maintains complete and up-to-date documentation and files
  • Provides positive welcome to all clients and family members
  • Assists Manager in development and fulfillment of short/long term departmental goals
  • Minimum of three years of experience coordinating and developing office systems and procedures to include two years in a medical staff office performing credentialing functions
8

Msla-credentialing Coordinator Specialist Resume Examples & Samples

  • Processes provider credentialing applications in accordance with standards, regulatory requirements, and policies and procedures
  • Examines researches, enter data, files, and gathers all information necessary to process information received from providers to support the credentialing process
  • Maintains compliance with documentation standards for necessary verifications
  • Sends and receive medical provider applications and compliance documentation
  • Minimum of 1 year of experience performing healthcare credentialing
  • Intermediate level of proficiency with Microsoft Excel
  • Minimum of 1 year of experience performing customer service related duties
  • NAMSS Certification as a Certified Professional Services Manager (CPMSM) or Certified Provider Credentials Specialized (CPCS)
9

Credentialing Coordinator Resume Examples & Samples

  • Apply knowledge/skills to activities that often vary from day to day
  • Demonstrate a moderate level of knowledge and skills in own function
  • Require little assistance with standard and non-standard requests
  • Solve routine problems on own
  • Work with supervisor to solve more complex problems
  • Prioritize and organize own work to meet agreed upon deadlines
  • Work with others as part of a team
  • Supervision/guidance is required for higher level tasks
  • 1+ years of previous experience in a data entry or clerical role
  • Basic level of proficiency with Microsoft Excel and Word
  • Knowledge or medical terminology
  • Credentialing experience
  • Strong ability to multitask and work independently
10

Credentialing Coordinator Resume Examples & Samples

  • Reports to the Credentialing Services Manager and performs all day-to-day activities related to the credentialing and re-credentialing of facility provider
  • Responsible for processing a high volume of privilege requests from: Physicians, Renal Fellows, Nurse Practitioners, Physician Assistants, and Clinical Nurse Specialists
  • Review and track requests to add/remove practitioners to facilities in assigned divisions
  • Sends link and passwords to access application materials, reviews returned applications for completeness, follow up on any outstanding information or additional information needed, and performs primary source verifications
  • Follow up with non-responsive practitioners and assist with obtaining credentialing packets and other documentation
  • Enter and update practitioner information in the credentialing database maintaining data integrity standards
  • Organize and distribute information needed for committee meetings and for facilitating governing body votes. Maintain confidential files on all providers
  • Scan documentation of approved membership/privileges and privilege letters and ensure timely notification is sent to practitioners
  • Follow up on all outstanding vote requests and provide ongoing expirables maintenance
  • Serve as liaison between Credentialing Department and facilities to assist with education of and compliance with Medical Staff Bylaws
  • CPCS certification preferred
  • 2-4 years related credentialing experience and/or training: or equivalent combination of education and experience
  • Previous credentialing experience highly preferred
  • Excellent computer skills including Excel, Word, Database maintenance, and Internet use. Knowledge of MSOW credentialing software a plus
11

Credentialing Coordinator Resume Examples & Samples

  • Knowledge of related credentialing, privileging, accreditation and certification procedures, requirements and hospital operations
  • Works independently, is self-directed and effectively in a team high paced environment. Ability to organize, prioritize, coordinate and follow thru on multiple activities and tasks in a timely manner
  • Experience with State and Regulatory agency requirements as it relates to healthcare credentialing guidelines
  • Ability to communicate and present information to a wide variety of parties effectively
12

Credentialing Coordinator Associate Resume Examples & Samples

  • Develops and understanding of and adheres to established credentialing guidelines may assist credentialing coordinators or independently completes in-depth review of practitioner’s application and accompanying documents ensuring applicant meets facility guidelines and eligibility. Examines researches, enters data, sets up files and gathers all information necessary to process information received from providers to support and complete the initial, reappointment and expirable credentialing process. Utilizes various websites, contacts educational facilities and professional references to verify credentials. Ensures compliance with facility Medical Staff Bylaws, Rules and Regulations, policies and procedures for hospital clients and EmCare
  • Ability to take direction and quickly adapt to established guidelines, is self-directed and is successful in working in a high paced environment
  • Strong organization skills and attention to details are essential
13

Senior Credentialing Coordinator Resume Examples & Samples

  • Apply knowledge/skills to a range of moderately complex activities
  • Demonstrate great depth of knowledge/skills in own function
  • May coordinate work of other team members
  • High school diploma
  • 3+ years of healthcare provider credentialing, quality or compliance experience
  • 2+ years of experience working with compliance workflows and processing including NCQA policies and practices
  • 2+ years of Healthcare experience
  • Intermediate level of proficiency with MS Excel and Word
  • Ability to adapt to different technical programs and databases
14

Credentialing Coordinator Resume Examples & Samples

  • Bachelor's Degree in Healthcare Administration
  • 3+ years of credentialing experience in a hospital medical staff services department
  • Comprehensive knowledge and experience with credentialing standards according TJC and CMS standards
  • Strong database skills
15

Senior Credentialing Coordinator Resume Examples & Samples

  • Complete physician applications for the state medical licenses and hospital privileges; work closely with the state licensing boards and hospital medical staff offices
  • Help keep physician credentials up to date, administer tracking, and reminder system
  • Filing, data entry, and database maintenance
  • Responsible for confidential and time sensitive material
  • Other tasks as assigned
  • Ability to follow through all projects
  • Strong networking and communication skills across various internal departments
  • Bachelor’s degree or equivalent and two years work related experience
  • Prior credentialing experience required
  • Prior database experience and/or experience working in hospital administration desired
  • Good communication skills – written, telephone, and email. Must be articulate, personable, and able to make calls to hospital staff offices
  • Attention to detail, good computer skills – MS, Word, Excel
  • Must have high level of interpersonal skills to handle sensitive and confidential situations
16

Credentialing Coordinator Resume Examples & Samples

  • Create and maintain radiologists credentialing files
  • Research and obtain verifications of radiologist credentials
  • Coordinate with hospital/center and radiologists to complete credentialing process, including any additional documentation, verifications, references, and applications necessary
  • Notifies appropriate parties of changes in a radiologist’s status
  • File, maintain and update pertinent documents in credentialing files
  • Knowledge and understanding of filling out credentialing applications
17

Credentialing Coordinator, Direct Bill Resume Examples & Samples

  • Leads, coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility
  • Establish and maintain data entry in ProView for CAQH general data collection information
  • Reviews of all components of the application file and assists Therapists in completing provider enrollment applications
  • Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up
  • Prepares credentials file for completion and presentation to the managed care plan/insurance, ensuring file completion within time periods specified
  • Verify provider and group information with insurance companies (e.g. address maintenance, provider roster maintenance, contracted plan maintenance, etc.)
  • Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and contract issues as they arise
  • Assists with managed care delegated credentialing audits, conducts internal file audits
  • Utilizes the credentialing database and applicable tracking applications, optimizing efficiency, and performs query, report and document generation when necessary
  • Responsible for the accuracy and integrity of the credentialing database system and related applications
  • Monitors the initial, re-attestations and expirables process for all credentialed Physical Therapists, Occupational Therapists & Speech Language Pathologists, ensuring compliance with policies and procedures identified in the Plan contracts
  • Ability to communicate effectively, both orally and written
  • Ability to multi-task effectively
  • Knowledge of medical credentialing
  • Ability to analyze, interpret and draw inferences from research findings, and prepare reports
  • Working knowledge of clinical and/or Agency operations and procedures
  • Database management skills including querying, reporting, and document generation
  • Advanced knowledge of Microsoft Office (Excel, Word, Access, Outlook)
  • Knowledge and understanding of HIPAA and CMS guidelines
  • Experience related to managed care Allied Health credentialing is preferred
  • Medical billing knowledge and experience is preferred
  • Bachelor’s degree or; Associate’s degree plus 1 year of professional office experience or; High school diploma or GED and 3 years professional office experience
  • Professional office experience – may come from a variety of areas, but a background in healthcare is preferred
18

Credentialing Coordinator Resume Examples & Samples

  • 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, etc.)
  • Requests primary source verification from appropriate sources and follows-up on a timely basis to ensure processing turnaround times are achieved
  • 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, as well as expirables
  • Analyzes provider records for completeness, accuracy, consistency
  • Communicates and works with appropriate Medical Staff Office to resolve data discrepancies
  • Enters data accurately and completely in the credentialing software
  • Bachelor's Degree in Healthcare Administration preferred or equivalent combination of education, training, and experience is required
  • Three or more years of credentialing experience in a hospital medical staff services department
  • Database skills
  • Detail oriented with exceptional accuracy
  • Excellent organization, follow up, and prioritization skills
  • Strong interpersonal skills; ability to interact with internal staff as well as providers and provider office staff
19

Credentialing Coordinator Resume Examples & Samples

  • Handles reappointments for expirables for assigned accounts ensuring required documents are received and verifications completed within established deadlines
  • Develops, understands and adheres to established credentialing guidelines
  • May assist credentialing coordinators or independently completes in-depth review of practitioner’s application and accompanying documents ensuring applicant meets facility guidelines and eligibility
  • Examines, researches, enters data, sets up files and gathers all information necessary to process information received from providers to support and complete the initial, reappointment and expirable credentialing process
  • Utilizes various websites, contacts educational facilities and professional references to verify credentials
  • Ensures compliance with facility Medical Staff Bylaws, Rules and Regulations, policies and procedures for hospital clients and EmCare
  • Extensive and frequent verbal and written communications with Clinicians, Medical Staff Offices, educational facility, state licensing boards, professional references and internal company staff
  • Provides excellent customer service in accordance with EmCare’s customer service standards to all internal and external parties
  • Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow-up. Communicates issues to management in a timely manner as appropriate
  • Accurately maintains systems data bases and spreadsheets to track, follow-up and disseminate hospital privilege status to other department in a timely manner
  • Attend and participate in all team related meetings, work diligently to support company-wide and team goals; demonstrates trust and respect for other team members
  • Bachelor’s degree in related field preferred
  • Credentialing certification a plus
  • Demonstrated ability to take direction and quickly adapt to established guidelines
  • Self-motivated and successful in working in a fast paced environment
  • Strong organizational skills and a high level of attention to detail
  • Demonstrated proficiency with Microsoft Office applications; Word, Excel and Outlook
  • Experience conducting research using various websites
20

Credentialing Coordinator Resume Examples & Samples

  • Accurately complete & submit the following Provider applications (both Initial and Re-credentialing/Renewals) as required: 1. Payer Enrollment/Credentialing 2.Facility (Hospital/Dialysis Units/Other Entities) 3. DEA/Medical Licensure. Completion of applications also includes conducting any necessary follow-up to ensure timely completion of process
  • Update and maintain provider demographic information in credentialing database timely and accurately
  • Request and maintain updated credentialing documents from providers on an ongoing/as needed basis and prior to any expirations to ensure there is no lapse in coverage or provider status
  • Run regularly scheduled reports to address any outstanding applications, issues, and expiring information
  • Provide status updates on all credentialing requests to Supervisor and/or provider on a weekly or as needed basis
  • Establish and maintain positive & effective communication with providers, management, clients, and other identified stakeholders
  • Maintain confidentiality of provider credentialing files and information
  • Associates degree or 2 to 4 years related credentialing experience and/or training; or equivalent combination of education AND experience; Recent and relevant previous experience in provider credentialing HIGHLY preferred
  • Knowledge and thorough understanding of the credentialing process
  • Must have exceptional organizational skills, be accurate and detail oriented, use independent judgement and problem solving skills; and have the ability to meet tight turnaround times
  • Highly motivated self-starter that works effectively with minimal supervision
  • Excellent written/verbal/interpersonal communication and customer service skills
  • Intermediate computer skills and proficiency in: MS Word, Excel, Outlook; database management/maintenance;ability to pull/analyze reports; usage of internet for research purposes - Knowledge of Adobe Acrobat and credentialing software a plus
21

Credentialing Coordinator Resume Examples & Samples

  • Perform intake of credentialing applications, processing and inputting into the system
  • Re-credentialing of applications that come back through
  • Estimated 10-15 applications on a weekly basis
  • Experience with managed care, health insurance or medical insurance
  • Experience working in administrative or clerical role
  • Experience using MS Word and MS Excel in a professional environment with the ability to create documents and conduct data entry
  • 1+ years of experience in credentialing providers, working in provider relations, medical billing or quality management
  • Experience in utilizing credentialing software
  • NCQA experience highly preferred
  • Knowledge of CMS credentialing requirements
22

Credentialing Coordinator Resume Examples & Samples

  • Consistently exhibits behavior and communication skills that demonstrate HealthCare Partners (HCP) commitment to superior customer service, including quality, care and concern with internal and extern customers
  • Generates reports as requested via the credentialing system software (SyMed, One App). Participates in department projects as assigned
  • Enters and verifies data in the Credentialing system with a high degree of accuracy, efficiency, and dependability
  • Follows up with providers to ensure credentialing applications are returned complete and submitted timely
  • Performs monthly queries, updates expired licenses, DEA’s and malpractice certifications for providers and office locations
  • Independently take on administrative and credentialing duties that include completing credentialing applications in full for providers, tracking credentialing status, assisting with primary source verification
  • Maintains competencies and knowledge of current regulatory rules around Medicare and Medicaid applications, hospital applications, and ancillary clinician application requirements
  • Typing correspondence, copying, faxing, filing, training other team members
  • Occasional back up receptionist duties required
  • Minimum 2 years health plan experience required
  • Knowledge in CAQH, NPDB, PECOS a must
  • Hospital experience and / or former Provider Relations experience a plus
  • Proficient administrative experience a must
  • Must be proficient in Microsoft Office (Access/Excel/Word) and internet searches
  • Access database experience a plus
  • Knowledge of NCQA Credentialing standards
  • Ability to work collaboratively as a team
  • Ability to read, write, speak, and understand the English language fluently
  • Ability to communicate effectively gets along with coworkers and management, and deal effectively and professionally under pressure
  • Ability to establish and maintain effective working relationships with medical staff and credentialing personnel
  • Valid Florida driver’s license and the ability to commute
23

Credentialing Coordinator Resume Examples & Samples

  • Appointments/ Reappointments to the Medical Staff
  • Appointments/Reappointments to the Allied Health Professional Staff
  • Assisting in the processing of requests for temporary privileges
  • Maintains office files and current licensure/insurance information in collaboration with the credentialing process center CPC)
  • Generates the Emergency On-Call lists and distributes it on a timely basis
  • Provides day-to-day continuity of Medical Staff Office affairs
  • Provides other general support to the organized Medical Staff and as requested by the Department Director
24

Credentialing Coordinator Resume Examples & Samples

  • Conduct license monitoring process for all providers in accordance with license monitoring policy, to include initiation of letters, reports, and primary source verification of renewals
  • Monitor bi-weekly Human Resources report and update Credentialing database (CACTUS) as appropriate
  • Initiate initial credentialing through CAQH through “rostering” process
  • Initiate recredentialing process for providers due for recredentialing
  • Facilitate provider reattestations of CAQH data as required by CAQH
  • Supports the Credentialing Specialists’ as it relates to their day-to-day operating processes
  • Works with Group Health Payer Contracting Department on various credentialing products
  • Works with all colleague levels and cross-disciplinary groups regarding inquiries with respect to credentialing information and data requests
  • Ability to adapt to change/remain flexible, meet expected deadlines and act as a team player
  • Effectively communicate updates, ideas and concerns with respect to day-to-day responsibilities
  • 1-2 years related experience, or equivalent combination of education and experience
  • Knowledge of credentialing software (CACTUS) is a plus
  • Computer skills to include Word, Excel, Power Point, some Access, Lotus Notes (or similar email program) and ability to learn and utilize all proprietary Concentra software programs
  • Basic familiarity of credentialing as defined by legislative/regulatory or state bodies
  • Strong interpersonal and communication skills, both written and oral, with varying levels of colleagues and/or management
25

Credentialing Coordinator Resume Examples & Samples

  • Review provider credentialing applications for completeness and performs primary source verification within required timeframes
  • Responsible for written correspondence to providers and the health plan’s Provider Assessment Committee regarding provider’s credentialing status and or issues
  • Assists with managed care delegated credentialing audits and conducts internal file audits
  • Participates with credentialing and enrollment activities with governmental payers, commercial and managed care payers and networks
  • Correspond with providers, licensing agencies, educational institutions and various regulatory agencies to gather required verifications and information pertaining to credentialing
  • Maintain accurate credentialing information in Rediclinic’s credentialing system
  • Works with Quality/Compliance staff to request provider quality information required for recertifying. Works with operations team to request provider site surveys and maintains survey information in access database
  • Intermediate level familiarity with medical terminology, NCQA guidelines, federal contracting requirements, and certifications preferred
  • 3+ years experience in medical staff credentialing with certification. Previous credentialing processing experience within a HMO, PPO, or practice management group preferred
  • Proficiency in MS Word, Excel, Power Point and Credentialing Software
  • Good organizational skills with attention to detail
  • Ability to communicate effectively and accurately – verbally and in writing
  • Detail oriented with exceptional follow-through skills
  • Ability to multitask in a fast paced environment independently and prioritize work
  • Sound understanding of federal and state regulations as they relate to credentialing
26

Credentialing Coordinator Resume Examples & Samples

  • Apply knowledge/skills to complex activities
  • Plan, prioritize, organize and complete work to meet established objectives
  • Act as a facilitator to resolve conflicts on team; seen as key team member on project teams spanning more than own function
27

Credentialing Coordinator Resume Examples & Samples

  • Minimum: 2 Years prior experience in medical staff services field preferred
  • Experience in software programs currently used in the medical staff office strongly preferred
  • Working knowledge of Medical Staff principles and operations specific to regulatory expectations (TJC, NCQA, CMS, Title XXII etc). Medical terminology, Excellent verbal and written communication skills, problem solving, critical thinking ability
  • 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. (Applicants of the Shared Service areas and those specific to GSH Medical Staff)
  • Monitors reappointment mailings and responses in accordance with Medical Staff Bylaws and policies and procedures
  • Maintains the credentialing database and Meditech Provider Dictionary in application processing, appointment and reappointment
  • Maintains database for current privilege monitoring
  • Notifies house-wide physician privilege updates
  • Notifies supporting departments of needs of physician profiling in the processing of monthly reappointments
  • Maintains proctoring records of all Provisional physicians, monitoring and reporting proctoring status to Department Chairs, Committees of the Medical Staff and the Director of Medical Staff Services
  • Coordinates new physician entry by scheduling of interviews, coordinating ID badges, IS Meditech Training and Medical Record dictation number assignment
  • Processes Temporary Privileges in accordance with the Medical Staff Bylaws
  • Tracking and follow up of applications new or reappointed, mailing, OPPE/FPPE, sanction checks, queries monthly expirations & maintain non-staff dictionary
  • Filing, mailing, maintain ED call schedule and other duties as assigned
  • Receives incoming inquiries, problems and complaints, assisting in resolution and communication to the Director of Medical Staff Services
  • Prepares credentials agendas, attends credentials meetings, prepares minutes and follow-up, and reporting outcomes to Director of Medical Staff Services as needed
  • Perform general office and clerical work, including typing, filing, copying, faxing and mail-outs
  • Type routine correspondence to physicians and allied health staff members
  • Establish daily priorities with the Director of Medical Staff Services
  • Maintains credentials related supply inventory and order supplies as necessary
  • Give appropriate customer service to all patients, visitors, physicians, and co-workers while showing courtesy, compassion and respect
  • Demonstrate good problem solving skills, calling upon the Director of Medical Staff Services, as necessary
  • Chooses appropriate channels and times to discuss complaints and concerns
  • Maintains confidentiality of all matters of the Medical Staff Office
  • Participates in continuous quality improvement activities by making suggestions for improvement
  • Keeps the Lead Medical Staff Coordinator/Director appropriately informed of daily activities and developments
  • Performs all tasks in a timely manner
  • Seeks ongoing educational opportunities
28

Credentialing Coordinator Resume Examples & Samples

  • Adheres to established credentialing guidelines, completes in-depth review and analysis of practitioner’s application and accompanying documents ensuring applicant meets facility guidelines and eligibility
  • Examines researches, enters data, sets up files and gathers all information necessary to process information received from providers to support and complete the initial, reappointment and expirable credentialing process
  • Ensures compliance with facility medical staff bylaws, rules and regulations, policies and procedures for hospital clients and EmCare
  • Performs extensive and frequent verbal and written communications with clinicians, medical staff offices, educational facilities, state licensing boards, professional references and internal company staff, requiring professionalism and tact, to attain or provide all needed information quickly in order to expedite the credentialing of clinicians
  • Analyzes providers file for potential risk review and obtain malpractice coverage for all contracted providers thru appropriate entity
  • Ensures proper interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statutes and laws relating to credentialing
  • Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow-up
  • Communicates issues to management in a timely manner as appropriate
  • Achieves compliance with credentialing department metrics and performance standards by adhering to the credentialing process and documenting accurately in company databases
  • Accurately maintains systems data bases and spreadsheets to track, follow-up and disseminate hospital privilege status to other departments in a timely manner
  • Generates and manages various reports for management, implementing best practices and working on projects as assigned
  • Attends and participates in all team related meetings
  • Participates in developing and implementing company-wide and team goals
  • Participates in problem-solving and decision making
  • Positively supports and adheres to corporate and division management decisions, being flexible and adaptable to change, establishing trust and respect for other team members and completing training as required
  • Manages work to tight deadlines, while maintaining both speed and accuracy
  • Minimum of two years credentialing experience required or equivalent combination of education and experience
  • Works effectively in a high paced team environment
  • Ability to organize, prioritize, coordinate and follow through on multiple activities and tasks in a timely manner
  • Demonstrates proficiency in use of Microsoft Office applications; Word, Excel, Outlook; and conducting research using various websites
  • Willingness to expand working knowledge of the locum tenens business and stay informed about market and competitive issues through research and professional networking
  • Willingness to take classes and participate in learning opportunities, both within and outside the company
29

Credentialing Coordinator Resume Examples & Samples

  • Enter data on all incoming EPMG and Ergency applications
  • Review EPMG application and CV for time gaps and completeness. Obtain explanation for all time gaps from practitioner
  • Generate an administrative, confidential and health file on all incoming EPMG & Ergency applications with proper labels
  • Verify all state medical license(s) held by practitioner currently and in the past
  • Verify all malpractice carriers held by practitioner currently and for the past 6 years
  • Produce and send letters and forms to verify practitioner diploma, internship, residency, hospital affiliation(s), and references
  • Request ECFMG, NPDB and AMA or AOA profile reports on practitioners who were issued an EIF after initial data entry of their EPMG application
  • Monitor non-returned verifications, produce and send out 2nd and 3rd verification requests when needed
  • Review all incoming verifications, ECFMG, NPDB, and AMA or AOA profile reports. Complete red flag form to inform and obtain signatures from RVP, Medical Director, Credentials Director, PRD VP, HR Director, and Vice President of Risk Management on all unsatisfactory verifications, reports and profiles. Unsatisfactory is defined as any verification with a checkmark indicated below satisfactory or any negative comments
  • Contact institution if verification is incomplete, blank, or inconsistent with practitioner’s CV/application
  • Provide Physician Assistants working in Indiana, Ohio, and Virginia with appropriate state supervision forms attached to the hospital staff application. When returned follow up with Medical Director, if needed, in obtaining signatures and forward to the state agency
  • Review completed staff applications for accuracy including assisting the practitioner in filling out staff application correctly, forwarding the staff application to appropriate hospital with required documents, and requesting and forwarding checks for facility staff application fees
  • Produce and mail or fax verification letters when required by hospital. Provide the hospital’s MSO with copies
  • Contact hospitals’ MSO for follow-up and assistance with obtaining required verifications and documentation for obtaining practitioner privileges
  • Assist MSO with copies of renewed licenses and/or certificates, re-appointment paperwork, dues, malpractice insurance, and termination questions. Query database on whether or not EPMG has a copy of documents needed or if a term date has been indicated
  • Assist MSO with dues and re-appointment paperwork
  • Inform the assigned Medical Director, Recruiting and Scheduling staff when privileges and malpractice coverage are granted on a practitioner
  • Communicate privilege problems with assigned Medical Director, Recruiting and Scheduling staff, when issues arise
  • Meet with new practitioners during an office orientation to review EPMG and facility staff applications and documents needed, if any
  • Perform practitioner-credentialing process in accordance with current CVO policies and procedures
  • Provide MSO offices with termination and withdrawal notices
  • Track all applications mailed, returned, and forward to the billing company weekly and follow up on applications not returned
  • Notify appropriate billing company of locations for all new employees
  • Notify billing company monthly of terminations
  • Assist billing company personnel in obtaining updated copies of employee license and/or certifications as needed
  • Assist billing company with employees who have outstanding charges because their provider enrollment paperwork is not complete or has items missing which are preventing them from being enrolled
  • Provide assistance to medical offices and/or pharmacies calling in needing UPIN, DEA, license numbers etc
  • Process requests for itemized medical bills
  • Obtain copy of providers NPI email confirmation
  • Generate and present ideas for improving Credentials Coordinator position and Credentials
  • Ability to communicate clearly and appropriately, both written and orally
  • Ability to organize work independently
  • Detail oriented with the ability to follow through with details accurately and consistently
  • Ability to make appropriate judgments
  • Ability to prepare complete physician/physician assistant credentials files and maintain them
  • Knowledge of computer systems, specifically word processing and database applications
  • Ability to quickly and accurately establish priorities in response to changing daily needs and/or procedures
  • Ability to carry out recommendations and directions
  • Bachelor’s degree in an applicable discipline or; Associate’s degree plus 3 years of professional office experience or; High school diploma and 5 years’ professional office experience
  • Professional office experience may come from a variety of areas, but health care credentials experience is preferred
  • Certification by the National Association Medical Staff Services (NAMSS), Certified Professional Credentials Specialist (CPCS) is preferred
30

Credentialing Coordinator Resume Examples & Samples

  • Associates of Science degree or two- to four-years of combined education and credentialing/contracting experience within a healthcare environment
  • Basic computer skills using MS Word, Excel and Outlook applications
  • Experience in database maintenance and Internet applications
  • Demonstrated ability to work in a team, facilitate effective team interactions, and to foster a positive work environment; willingness to assist teammates in order to achieve departmental goals
  • Demonstrated strengths in organizational, attention-to-detail, follow-through, analytical, reasoning, critical thinking, and problem-solving skills
31

Department of Medicine Credentialing Coordinator Resume Examples & Samples

  • Must possess excellent interpersonal, communications and problem-solving skills along with excellent attention to detail and follow-through
  • Must be a team-player and have a demonstrated ability to juggle multiple tasks and competing priorities
  • Must be able to work independently, exercise discretion, and maintain strict confidentiality
  • Exceptional organizational skills and ability to organize time and priorities effectively, asking for direction when appropriate. Flexibility to handle multiple tasks and deadline pressures
  • Demonstrated excellent writing and editing skills
  • Must be proficient in Microsoft Office applications, Word, PowerPoint, Excel and other Microsoft Office programs
  • Experience with Adobe Professional and Microsoft Access desired, but not required
32

Credentialing Coordinator GI Associates Resume Examples & Samples

  • Facilitate, oversee, and ensure timely completion of the appointment, reappointment, promotion and new hire process for professional and non-professional staff in the Gastroenterology Division
  • Work with Department of Medicine credentialing, Massachusetts General Medical Office, non-employee office, and Harvard Medical School faculty affairs to determine required paperwork for credentialing, appointments, reappointments, and promotions and facilitate completion of paperwork through correspondence with personnel
  • Complete of Reasonable Inquiry verifications requested by outside institution
  • Draft and/or review promotion, new appointment, and offer letters for finalization by the Chief
  • Process non-employee requests, including correspondence with non-employee office and applicants to ensure completion of required paperwork
  • Maintain accurate and complete records for all paid and unpaid professional and nonprofessional staff
  • Assist with measures implemented to track research staff adherence to institutional compliance mandates (ie Occupational Health, CAP training, annual vaccination requirements, required training programs, etc) documents compliance, and maintains records of these documents
  • Facilitate, process, and maintain records for annual employee performance evaluations (ie sends forms to managers and notifies them of upcoming evals due, provides copy to Administrative Director of Research for processing, and sends original to HR records)
  • Maintain, update, and format CVs for faculty
  • Maintain updated records on current and former trainees for inclusion in tables and progress reports required for NIH T32 program
  • Coordinate with Partners International Office to ensure timely submission and processing of visas and immigration documentation for non-U.S. citizens
  • Maintain complete, accurate, organized file for GI faculty, including updated CV
  • Coordinate Fellowship application and interviewing process; maintain ACGME accreditation; provide ongoing support to Fellows
  • Ensure that professional staff are scheduled for Annual Career Conferences annually with Chief; collect and file ACC forms
  • Assist Chief and Clinical Chief with drafting and formatting of formal written correspondence including letters of support and letters of recommendation for research collaborators, pre- and post-doctoral trainees, and faculty appointments and promotions
  • Work with HR recruiter and/or scientific journal job posting sites to post positions for staff and faculty, as needed
  • Arrange for interviews of faculty applicants, collect letters of reference, and assist with processing of travel reimbursement
  • Assist with day-to-day operations of Chief’s office, including provision of phone coverage, as needed
  • Work collaboratively with Division’s research management team to address research credentialing issues
33

Credentialing Coordinator Resume Examples & Samples

  • Assists with database integrity and maintenance
  • Completes files efficiently, according to policy and within the established standards and guidelines
  • Maintains excellent communication (verbal, written and electronic) with all customers of the CVO including, but not limited to, the practitioners and the entity users
  • Performs data entry and scans accurately and efficiently according to established policies, procedures and guidelines
  • Performs primary source verification, records information received and provides follow up as necessary according to established policies and procedures
  • Processes applications expeditiously and efficiently according to the established priorities and time frames
  • Excellent data entry and computer software application skills required and must have a desire to maximize the use of technology to automate processes
  • Detail oriented person with excellent communication and interpersonal skills required
  • Prior credentialing experience preferred
  • Experience with both JCAHO and NCQA standards preferred
34

Credentialing Coordinator, Senior Resume Examples & Samples

  • Overseeing day-to-day credentialing operations including but not limited to: ensuring credentialing files are processed timely and in compliance with regulations, timely license and DEA renewals, ongoing monitoring, and hospital privilege applications
  • Coordination with System Central Verification office to coordinate credentialing workload and align global dates in conjunction with other System facilities
  • Serve as department ECHO Super User; pull and analyze credentialing reports and establish and adhere to guidelines for standard work
  • Manages completion of external IPA credentialing applications and ensures all applications are completed within required timeframes
  • Develops, implements, and improves departmental policies and procedures
  • Oversees audits related to Managed Care delegated credentialing and centralized verification office on an as-needed basis
  • Oversees all delegation agreements and ensures compliance with requirements
  • Oversees all credentialing reports and ongoing monitoring
  • Interacts with internal and external physicians, departments, health plans, hospitals and regulatory agencies to resolve credentialing issues
  • Responsible for the accuracy and integrity of the credentialing database
  • Responsible for tracking departmental metrics and identifying areas for improvement
  • Oversees Credentialing Committees and approval of clean files between committee cycles
  • Minimum of five years’ experience working in healthcare with 3-5 years previous credentialing experience required
  • Experience working with various healthcare industry regulatory agencies and requirements including but not limited to CMS, NCQA, DMHC, ICE, DHCS, preferred
  • ECHO experience strongly preferred. Proficiency in Microsoft Office applications including Word, Power Point, Excel, and Outlook is a must
35

Credentialing Coordinator Resume Examples & Samples

  • Responsible for the timely processing of credentialing and re-credentialing applications and tracking of pending credentialing information for network providers
  • Responsible for reviewing and verifying all credentialing documentation for network providers, confirming consistency and accuracy based on regulatory requirements
  • Coordinates review and approval of clean files by CMO/SMD
  • Schedules, coordinates, and prepares for credentialing committee meetings including but not limited to: booking meeting rooms, sending out meeting requests, preparing documents, assembling binders, and reserving lunch
  • Coordinates with various departments including Risk Management and Quality Improvement for report preparation for credentialing committee
  • Responsible for committee finalization, including but not limited to: mailing and filing of approval letters/sheets, organizing minutes for the minute’s binder, and entering approval dates in the credentialing database
  • Assists Director with managed care delegated credentialing audits on an as needed basis
  • Maintains accuracy and integrity of the credentialing database
  • Maintains network provider credentialing files and conducts internal file audits to ensure accuracy and efficiency throughout the credentialing process
  • Responsible for monthly network provider licensing expirables, renewals, and updates
  • Responsible for Ongoing Monitoring, semi-annual, and quarterly reports
  • Responsible for credentialing and re-credentialing internal providers with hospitals, IPA’s, medical groups, and health plans on an ongoing basis
  • Prepares and sends check requests and appropriate documentation for hospital privileging, licensing renewals, and credentialing verification fees and payments
  • Works with internal and external customers on day-to-day credentialing and privileging issues and requests as they arise
  • Perform any additional duties as requested by management within the scope of knowledge
  • Qualified candidate must excel in interpersonal communication and customer service and be able to work both independently and as part of a team
  • They must excel in organization, attention to details, prioritization and follow through
  • Additionally, they must have the ability to problem solve to logical conclusion and demonstrate initiative and responsibility
  • Must have good listening skills
  • Be able to effectively and clearly communicate (written and verbal) in English
  • Minimum of two years provider credentialing experience and experience working with various healthcare industry regulatory agencies and requirements including but not limited to CMS, NCQA, DMHC, ICE, DHCS, preferred
  • Proficiency in Microsoft Office applications including Word, Power Point, Excel, and Outlook is a must
36

Credentialing Coordinator Resume Examples & Samples

  • Ensure appropriate and timely processing of initial credentialing application and recredentialing activities, while meeting or exceeding departmental productivity benchmarks
  • Monitor Work in Progress (WIP) file, promptly addressing incoming files for processing
  • Review all applications for accuracy and completeness, and receipt of credentialing fees
  • Facilitate prompt coordination with the Credentialing Verification Organization (CVO) to ensure prompt processing of Primary Source Verification is conducted in a timely manner further ensuring overall processing timeframes are met
  • Generate forms, letters, checklists, and maintain the internal tracking data base/data entry, ensuring complete and accurate data entry
  • Coordinate with Network Services or other sources as necessary on follow-up items needed to complete the credentialing process
  • Maintain credentialing files, ensuring compliance, accuracy and completeness (including but not limited to merging documents, and ensuring the credentialing file is complete)
  • Conduct internal and external validation of credentialing file audits, and address identified issues in a timely manner
  • Ensure timely processing, and ensure timely responses and/or notifications that apply to audits, site visits, or records review
  • Generate daily/weekly/monthly reports for tracking turn-around times, and file/application status, and follow-up on identified issues in a timely manner
  • Communicate to Network (or other internal departments) regarding status of provider and organizational credentialing
  • Collaboration with the Credentialing Manager, communicating identified issues or concerns, and participating in resolutions or corrective actions
  • Credentialing applications are processed timely, and in compliance with regulatory agencies
  • Ensures appropriate reporting, demonstrating compliance with processing standards as well as ability to promptly identify and address issues or concerns
  • Ensure appropriate preparation of the Credentialing Committee meeting, promoting effectiveness and efficiency
  • Ensure demonstration of complete and accurate documentation and compliance across all areas of Credentialing activities
  • Prompt and thorough addressing of special projects promotes adherence to regulatory standards, and facilitates ability to sustain compliance in respective areas
  • Demonstrated participation increases effectiveness and efficiency throughout the department, as well as contributes toward the development of standardized practices in the industry
37

Credentialing Coordinator Resume Examples & Samples

  • Responsible for all aspects of Credentialing of Institutional and Individual Providers
  • Preceptor to others in duties related to Credentialing
  • Cross-trains other staff for major job responsibilities as appropriate for optimum functioning
  • Serves as liaison between the medical staff and plan administration
  • Oversees medical staff credentialing activities during initial appointment
  • Oversees medical staff credentialing activities during re-appointment
  • Precepts and mentors designated medical staff personnel
  • Coordinates medical staff with regulators
  • Assist with facilitation of Medical Staff meetings
  • Responsible for all phases of preparation for Medical Staff Credentialing meetings, including production of agenda, documents for review and for personal review and preparation of medical staff in advance as needed to facilitate informed participation
  • Responsible for accurate and timely recording of minutes of all Medical Staff Credentialing meetings
  • Assists medical staff in enforcing medical staff bylaws, rules and regulations, policies and procedures, and identifies /communicates the need for revisions and additions as needed
  • Tracks, on an on-going basis current licensure required for physicians and allied health professionals
  • Records and tracks medical staff meeting attendance, as required by medical staff bylaws for maintaining staff status
  • Provides support for medical staff and Plan Administration for Due Process Proceedings by attending hearings and appeals meetings and recording proceedings
  • Tracks monitoring/proctoring documentation necessary for the granting of special or new privileges to physicians
  • Assists with coordination of collection of information for additional review for any applicant whose initial or recredentialing process reveals factors that may impact on the quality of care or services delivered to consumers
  • Updates on a daily basis the physician/AHP data base for the credentials database, and keeps current Medical Staff Services Department credentialing computer system
  • Active participant in health plan's compliance with the standards of URAC Credentialing Accreditation
  • Communication, Coordination, Collaboration with all customers, internal and external
  • Assists Quality Management Department with special projects
  • Serves as liaison to medical staff in matters of credentialing and related issues
  • Manages projects and timelines to achieve highest quality work within allotted period
  • Some college or 4-6 years executive secretarial or healthcare management experience, or prior Medical Staff Coordinator experience preferably in a hospital or healthcare plan environment
  • Must possess organizational skills necessary to manage the credentialing office, coordinate activities of the medical staff, and provide follow-up documentation
  • Attention to detail, ability to prioritize, good judgment, excellent customer service and computer literacy skills a must
  • Proficiency in Word Processing and Spreadsheet applications
  • Considerable independent discretionary capacity related to interpretation and application of state and federal regulations
  • Must be able to work independently 80-95% of time
  • Ability to work occasional long or irregular hours
  • Good speaking ability, judgment, and initiative
  • Minimum two years prior experience as a Medical Staff Coordinator or equivalent position
  • Prior experience as Credentialing Coordinator in a health plan preferred
38

Credentialing Coordinator Resume Examples & Samples

  • Review all provider credentialing and re-credentialing applications for completeness
  • Review and analyze credentialing documents, including education, residency and fellowship training, board certification and eligibility, licensure, professional work history, liability insurance, requests for clinical privileges and malpractice history
  • Assess completeness of information and provider’s qualifications relative to established standards
  • Determine appropriate verification and reference letters to be prepared for adequate processing of each individual application and reapplication
  • Identify and flag adverse information from provider application materials for the purpose of conducting special follow-up investigations
  • Request facility site reviews from appropriate source (i.e. CalOptima) on applicable providers
  • Responsible for the generating, mailing, tracking, and subsequent processing of provider re-credentialing applications. All re-credentialing files are to be completed within 36 month timeframe. Requires following Prospect Medical policy and compliance schedule for sending up to 3 requests starting 6 months prior to credentialing expiration and making follow up calls according to policy
  • Maintain 80% accuracy rate on the number of files submitted for the credentialing committee(s)
39

Credentialing Coordinator Resume Examples & Samples

  • Maintain a working knowledge of the Health Partners governing documents (ie – Operating Agreement, Credentialing Policy, Allied Health Professional (AHP) Policy, etc.)
  • Coordinates all office activities related to credentialing including processing of initial applications and reappointments for all participating physicians and allied health professionals
  • Responsible for validation, maintenance and updating credentialing and provider changes in credentialing database
  • Education: Associate degree in administration, health or behavioral science field preferred
  • Licensure / Certification: Certified Professional Credentialing Services (CPCS) and/or Certified Professional Medical Staff Services Management (CPMSM) certification preferred; (National Association of Medical Staff Services)
  • Experience: Minimum of two years experience performing administrative duties
  • Experience working with physicians preferred. Credentialing experience preferred
  • Knowledge of medical terminology preferred
  • Knowledge of basic and credentialing computer software including internet use and spreadsheets preferred
40

Credentialing Coordinator Resume Examples & Samples

  • Initiates onboarding process for contracted medical and dental service providers
  • Examines research, enters data, files, and gathers all information necessary to process information received from providers to support the credentialing process
  • Maintains compliance with documentation standards for necessary verification
  • Establishes productive relationships with medical providers and office staff to facilitate prompt integration into company network
  • Assists and provides customer service to onboarding providers
  • Collects and processes executed contract documents
  • Reviews received documentation to ensure 100% completion and accuracy
  • Associates degree (or higher) or equivalent to two year college or technical school or High School diploma / GED and 2+ years credentialing experience
  • 1+ years of credentialing experience
  • Knowledge of NCQA credentialing standards
  • Knowledge of best practices and industry standards for credentialing processes
41

Credentialing Coordinator Resume Examples & Samples

  • Complete client, state, and online applications on behalf of providers’ and assist in reviewing requirements including licensure, certifications, screens and other critical documents using the internal systems such as SharePoint, SBDev, and future state will be Salesforce. These systems assist to determine healthcare professionals’ document status versus requirements needed for specific assignment in order to pursue outstanding requirements
  • Communicate professionally in a timely manner using various mediums of communication such as email, phone, or internal communication mediums such as notes to facilitate a team approach to gathering all required documents, for example education verifications, obtaining phone and fax numbers for past work history, requesting case logs, etc
  • Run reports for both workforce planning and pending starts meetings for various specialties throughout the department, paying attention to unique identifiers per specialty and maintain consistency throughout the various meeting types
  • Coordinate credit card reconciliations for leaders across the department by working closely with each leader to ensure all receipts and charges are accounted for
  • Facilitate internal tracking system (SharePoint) to assist in the maintenance of data, building internal benchmarking for team members and assisting in supporting the team member to ensure the data reflects real-time status
  • Collaborate with Credentialing Analysts to review all incoming new client requests or contract revisions for Credentialing requirements, for assigned facilities in order to identify unique requirements
  • Provide administrative support to the Credentialing Analysts teams by completing check requests, scheduling drug screens, completing follow-up calls, creating FedEx labels, etc
  • 1 to 3 years previous experience in an administrative setting
  • 1 to 3 years of experience with Microsoft Suite
42

Credentialing Coordinator Resume Examples & Samples

  • Ensure provider's files are accurate and complete at the time of initial credentialing and re-credentialing
  • Pull files and assist with processing of credentialing/re-credentialing applications
  • Check CAQH for reapplication six months prior to the re-credentialing date
  • Request re-credentialing application and updated documents from UAM's providers six months prior to the re-credentialing date
  • Make attempts on the follow-up for re-credentialing applications and requested documents and notify local Provider Relations Representative to assist
  • After reapplication is received ensure it is complete. If not complete make attempts to follow-up with provider and notify Provider Relations Representative to assist
  • Send verification request to the applicable agencies
  • Follow-up with the agencies until verification is received
  • Data enter verification dates into credentialing database
  • Data enter all delegated provider information into credentialing database
  • Maintain all data for additions, terminations, and changes into credentialing database
  • Assist with delegation audits as requested
  • Perform on-going monitoring of licenses, sanctions, Medicare opt-out, quality of care as directed
  • Update Board Certification upon expiration to support HEDIS reporting
  • Assist with CMS, internal Health Plan, and Compliance audits as requested
  • Coordinate information as directed by the Credentialing Manager for monthly committee meetings
  • Assist with requests from other departments for credentialing information
  • Customer service skills with the ability to interact professionally and effectively with providers, third party payers, physicians, and staff from all departments within and outside the Company
  • High School diploma required
  • Medicare Advantage experience preferred
  • Minimum one year credentialing experience in Medical Group/IPA or health plan setting
  • Experience working with NCQA and CMS credentialing guidelines
  • Personal computer experience should include working with Microsoft Word, Excel, PowerPoint, Outlook, and Access at the intermediate level at a minimum
  • Experience working in a company with a compliance focus where adherence to Plan, CMS, NCQA standards and state and federal rules and regulations was required
  • Experience working in an environment where strict confidentiality is required
43

Credentialing Coordinator Resume Examples & Samples

  • Two to three (2-3) years of general office experience
  • Background in business and office procedures
  • Typing at a min. of 55-60 wpm
44

Credentialing Coordinator Resume Examples & Samples

  • Efficient and timely preparation and submission of complete and accurate initial credentialing and recredentialing applications for the non-delegated payors
  • Processes applications expeditiously and efficiently according to the established priorities and timeframes
  • High school or equivalent and two years work experience required
45

Credentialing Coordinator Resume Examples & Samples

  • Maintain database of key licenses, certifications, and credentials on facility physicians and mid-level providers, including all due dates for revalidations, re-privileging and malpractice insurance renewals
  • Using information from the database, assist Acadia facilities in completing
  • Applications for physician and facility participation in payor programs, including Medicare Forms 855A, 855B, 855R and similar applications for state Medicaid programs, and managed care plans
  • Facility entries in Medicare’s PECOS database
  • Applications for facility medical staff privileges
  • Applications for medical malpractice coverage
  • Work with other Acadia departments to ensure a smooth physician onboarding process, including the following departments on the following and other tasks
  • Compliance, in ensuring physicians maintain required privileges and credentials
  • Legal, in its review of physician contract terms
  • Recruiting, in onboarding new physicians and identifying recruitment needs
  • Treasury, in obtaining electronic funds transfer instructions to be provided to payors
  • Risk Management, in providing data needed for its insurance and underwriting needs
  • Human Resources, in verifying the credentials of employed professionals; and
  • Information Technology, in developing and maintaining the database
  • Assist Corporate Director of Managed Care with contracting needs and reports
  • Track utilization of locum tenens clinical providers at facilities
  • High school diploma or equivalent; prefer some college or technical school coursework
  • Minimum 5 years of job-related experience
  • Advanced computer skills including Microsoft Office; especially Word, Excel, and PowerPoint
  • Knowledge of office administration procedures with the ability to operate most standard office equipment
  • Exercises sound judgment in responding to inquiries; understands when to route inquiries to next level
  • Self-motivated with strong organizational skills and superior attention to detail
  • English sufficient to provide and receive instructions/directions
46

Credentialing Coordinator Resume Examples & Samples

  • Establishes and maintains a system for timely processing of credentialing and recredentialing files in accordance with ConnectiCare, CMS and NCQA policies
  • Ensures that providers/HDOs on ConnectiCare's participating panel are in compliance with ConnectiCare policies and NCQA and state and federal regulatory standards
  • Maintains current knowledge of NCQA, state and federal requirements
  • Performs data entry in and maintaining currency of the database for tracking practitioner/HDO credentialing and recredentialing information
  • Initiates and conducts primary source verification of provider credentials
  • Reviews credentialing and recredentialing applications against CCI credentialing standards to determine if candidates are appropriate for ConnectiCare's practitioner panel and processes applications accordingly
  • Assembles all verified information and prepares files for presentation to the Medical Director and/or ConnectiCare's Quality Improvement Committee for approval or recommendation to not credential
  • Maintains communications with provider offices to promote relationships imperative to process
  • Modifies and designs reports and queries to demonstrate the effectiveness of the credentialing/recredentialing process
  • Queries appropriate organizations (Hospitals, National Practitioner Database (NPDB), & The Joint Commission (TJC)) and evaluates responses to ensure provider compliance with ConnectiCare and NCQA standards
  • Performs ongoing monitoring through NPDB, Medicare Debarment Reports and Office of Inspector General (OIG) reports
  • Obtains all relevant documents and ensures that the applicant completes his/her ConnectiCare or Council for Affordable Quality Health (CAQH) Universal application within the specified time period
  • Coordinates and ensures orderly workflow of provider files to appropriate individuals, committees and departments
  • Maintains credentialing databases consistent with information in Amisys by processing Practitioner Change Forms and on-going audits
  • Coordinates with delegates to ensure all necessary information regarding credentialing and recredentialing is received and entered in a timely basis
  • Performs other related projects and duties as assigned
  • Associates Degree or an equivalent combination of education and experience
  • At least 2 years of previous experience in a health insurance environment, preferably in provider relations or credentialing
  • Knowledge of NCQA and CMS requirements preferred
  • Strong personal computer skills, especially proficient in databases and use of internet
  • Strong knowledge of Amisys Advanced
  • Excellent oral and written communication and interpersonal skills
47

Credentialing Coordinator Resume Examples & Samples

  • Performs quality review of medical staff credentialing files
  • Peer reviews files for accuracy and adherence operating policies, procedures and agency regulations
  • Provides guidance to support staff in initial credentialing, reappointment and audit activities. Performs follow-up and issue resolution, as needed
  • Ensures credentialing files are prepared for committee reviews
  • Provides administrative support at various medical staff committee meetings (i.e. site credentialing committees, Medical Board, Combined Bylaws committee, etc.)
  • Creates meeting agendas, takes minutes, provides follow-up activities
  • Prepares and distributes correspondence by Medical Board, Medical Staff Officers and Administration. Generates reports related to motion activity, privileges, appointments, status changes, etc
  • Coordinates administrative functions for various auditing activities
  • Ensures credentialing records are prepared for audits performed by managed care companies, Department of Health, Joint Commission, healthcare facilities, legal entities, etc
  • Serves as a liaison to marketing and IT departments to ensure the Health System’s Medical Group Faculty Directory provides appropriate, up-to-date information to internal and external users
  • Minimum of three (3) years administrative support experience, required
  • Proficient in PC applications (Microsoft Excel, PowerPoint, Word). Ability to produce high quality reports, presentations, or other documents
  • Excellent communication skills (verbal, written and presentation), required
48

Credentialing Coordinator Associate Resume Examples & Samples

  • Coordinates file review and approval by Credenialing Manager as required
  • Maintains current documentation and updates in EmTrac
  • Coordinates with hospital/clinic, medical staff, and practitioners to complete privileging process, including any additional documentation, verifications, references, and applications necessary
  • Assists EmCare clients with reappointments as requested
  • Adhere to all company policies and procedures. Perform other duties as assigned
  • Computer skills required: databases, Microsoft Word, Excel, and Lotus Notes
49

Credentialing Coordinator Resume Examples & Samples

  • Recent credentialing/medical services or closely related experience
  • Experience in the use of credentialing software strongly preferred
  • Experience working directly with physicians and their offices on appointment/reappointment process
  • Knowledge of Joint Commission and governmental regulatory requirements
  • Demonstrated speed and accuracy of data entry
  • Very strong clerical and organizational skills
  • Experience in use of Microsoft Word, Outlook, Excel, etc
50

Credentialing Coordinator Resume Examples & Samples

  • Coordinates the credentialing and recredentialing process for assigned providers
  • Collects and maintains all pertinent information from the provider. Communicates consistently with providers and provider office staff in a timely and effective manner to follow up to obtain required documents on a timely basis in alignment with processing guidelines
  • Verifies all credentialing elements, including but not limited to, education, training, board certification, work history, licensure and certifications, malpractice coverage
  • Through a variety of primary sources as appropriate per NCQA and The Joint Commission standards
  • Analyzes provider files for completeness, accuracy, consistency, gaps in work history, relevant references, etc. Identifies issues and initiates further data collection as needed. Communicates handoff to appropriate Medical Staff Office
  • Maintains thorough understanding of NCQA, The Joint Commission, and Commonwealth of Massachusetts credentialing standards
  • Manages expirables as assigned
  • Organizes and maintains paper and electronic files as required
  • Meets assigned file processing quality and quantity standards
  • Generates routine reports to assure timeliness of verifications, appropriate recredentialing dates, and processing of expirables
  • Performs routine file audits
  • Bachelor's Degree in Healthcare Administration, related field, or equivalent combination of education, training, and experience is required
  • Three or more years of credentialing experience in a managed care plan, or hospital medical staff services department
  • Experience with file processing according to NCQA and TJC standards
  • National Certified Provider Credentialing Specialist Certification preferred
51

Credentialing Coordinator Resume Examples & Samples

  • Responsible for creating Physician Reference Guides (PRG) in the department’s Access Credentialing Database for new physicians
  • Responsible for CAQH on-line credentialing set up and maintenance efforts
  • Accurate and timely submission of Managed Care Credentialing & Re-credentialing applications for physicians and paraprofessionals
  • Timely follow-up phone calls & documentation on a monthly basis to verify that credentialing applications have been received, until effective date is obtained
  • Composing email notifications regarding participation effective dates for providers to appropriate market contacts, office & billing staff members
  • Responsible for developing and updating Contract Summary Sheets with physician effective dates and contract reimbursement amounts
  • Responsible for requesting/downloading Fee Schedules on a yearly basis from the Managed Care companies and coordinating the washing/loading process with the Fee Schedule Coordinator
  • Responsible for updating the Re-credentialing portion of the database and auditing plans quarterly to ensure all re-credentialing efforts are current
  • Updating Managed Care Monthly (MCM) Updates with provider’s effective dates
  • Notifying Managed Care plans regarding practice changes such as add/term locations & add/term providers and completing monthly follow up phone calls & documentation on open requests, until process is complete
  • Assist other departments with credentialing and contracting issues as it pertains to claims
  • Other duties may be assigned as the managed care industry changes
  • Must be proficient in MS Office
  • Advanced Excel Skills are required
  • Must have legible printing/handwriting
  • Knowledge of CPT & HCPCS codes
  • Good organizational, time management and communication skills
  • Must be able to effectively communicate with physicians, co-workers, supervisor, and outside contacts
  • Must be able to handle multiple tasks in a fast paced environment
  • Adheres to company policy and procedures
  • Must be able to understand and speak English Fluently
  • Must have a High School Diploma or equivalent
  • Applicant must have 3 years of credentialing experience in a physician office or health plan environment
  • Experience working with Access is helpful, but not required
  • Must be able to fluently speak, read and understand English
  • Climbing-No
  • Crawling-No
52

Credentialing Coordinator Resume Examples & Samples

  • Processes provider applications and re-applications; including the initial mailing, review and loading
  • Processes credentialing and re-credentialing applications of health care providers and assist in the implementation of related procedures and activities
  • Reviews applications, prepares verification letters and maintains database and provider profiling system
  • Communicates with providers, medical office staff, licensing agencies, and insurance carriers to provide status information and complete credentialing and re-credentialing applications
  • In-depth working knowledge of the various applications associated with the workflows
  • Ensure all workflow items are completed within the set turn-around-time within quality expectations
  • Responds to escalated issues by resolving or redirecting internally
  • High School graduate or the equivalent minimum experience required
  • Healthcare and revenue service center preferred
  • Communicates effectively with all internal and external clients, including managers, employees, vendors, support staff and visitors
  • Uses good judgment and critical thinking skills; ability to identify and resolve problems
  • Proficient in MS Office software; particularly Excel and Outlook
  • Efficient and accurate keyboard/typing skills
  • Possess a strong work ethic and a high level of professionalism with a commitment to client/patient satisfaction
  • Functional knowledge of HIPAA rules and regulations and experience related to privacy laws, access and release of information
53

Credentialing Coordinator Resume Examples & Samples

  • Credentialing experience in a hospital medical staff office (MSO) ), Physician Practice or Healthcare background
  • Demonstrated research and problem solving skills
  • Excellent oral and written communication as well as interpersonal skills with a focus on internal/external customer satisfaction
  • Ability to work under pressure and be adaptable to change
  • Proven dedication to quality, teamwork and professionalism
  • Advanced computer skills (MS Office Suite’s Word, Access, Excel, & Outlook; and the Internet)
  • Proficient in Credentialing MSO Software
  • High School Diploma or General Education Degree (GED) and 3 or more years of related work experience
  • CPCS Certification preferred
54

Physician Credentialing Coordinator Resume Examples & Samples

  • Skill in dealing with interpersonal issues and customer relations
  • Ability to comprehend and follow written and verbal instructions
  • The position requires at least two (2) solid years of medical office experience in a supervisory or lead role
55

Credentialing Coordinator Resume Examples & Samples

  • Coordinates DHS 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
  • Partners with Medical Staff Office personnel at all Dimensions 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
  • 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
  • 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
  • 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
  • Maintains credential files in required format to meet requirements of Joint Commission, CMS and for legal presentations
  • Is responsible for organization of, and completion of, specific projects as required to meet new regulatory requirements and/or system changes
  • Maintains a working knowledge of Medical Staff Bylaws of client facilities
  • Maintains credentialing compliance with the accrediting and regulatory agencies (i.e., Joint Commission) while developing and maintaining a working knowledge of the regulations
  • Is proactive regarding participation in available educational opportunities in the credentialing field
  • 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
  • Two or more years of college in business courses preferred
  • Two or more years experience in Medical Staff credentialing, working directly with physicians, mid-level providers and office staff demonstrating the ability to complete assigned tasks independently or with minimum supervision
  • Strong interpersonal and organizational skills required
  • Good computer skills with proficiency in Microsoft Word and Excel
  • Detail oriented, able to adapt to frequent work interruptions, handle multiple tasks, prioritize tasks, makes independent decisions, demonstrates flexibility and meets deadlines
  • Employee must demonstrate the ability to work as a cooperative team member
56

Credentialing Coordinator Lead Resume Examples & Samples

  • Supervises the creating, updating and generally maintaining medical staff credentials and licenses in accordance with the local file management practices and the electronic or manual record filing system
  • Oversees the retrieving, delivering and filing/storing records in accordance with daily scheduled, emergency and special project needs
  • Oversees the reviewing records for completeness and accuracy of required information content and taking appropriate actions to assure record integrity
  • Implements policies and procedures
  • Minimum 5 years working in credentialing
  • Minimum 1 year in a leadership position
57

Credentialing Coordinator Resume Examples & Samples

  • Coordinating calendars; organize and schedule meetings
  • Attend meetings and take detailed notes with action items
  • Office duties: maintaining files, making copies, collating, order supplies, open and sort mail, prepare items to be mailed
  • Creation of multimedia information tools: flyers, Google websites, presentations
  • Assist with data management and creation of scheduled and ad-hoc reports
  • Identify solutions for teacher compliance and ensure follow through
  • Drive to/from schools and local agencies to expedite the credentialing process
  • General support to office visitors
  • ​At least one year of administrative experience at an office setting
  • Strong critical thinking and communication skills
  • Excellent organizational, planning, and implementation skills
  • Data driven; Strong attention to detail and follow through
  • Excellent computer skills, experience working with Google platform a plus
  • Ability to work independently, set priorities, and complete work accurately and in a timely manner
  • Must hold a valid driver’s license and dependable transportation, as travel between school locations and local agencies will be required
  • Unquestioned commitment to KIPP LA’s mission and values
58

Credentialing Coordinator Resume Examples & Samples

  • General knowledge of credentialing processes, terminology and NCQA standards
  • Strong analytical skills, including process improvement and problem resolution
  • Must be detail-oriented with good organizational skills and able to maintain accuracy while meeting deadlines and production requirements
59

Credentialing Coordinator Resume Examples & Samples

  • Coordinates all office activities related to credentialing including processing of initial applications and reappointments for all participating physicians and allied health professionals. Responsible for validation, maintenance and updating credentialing and provider changes in credentialing database
  • Tracks and reports on the status of all physician and AHP applicants in process on a weekly basis to ensure that credentialing functions are being performed in a timely manner and in accordance with MCHS needs and regulatory agency requirements
  • Education: High School diploma. Associate degree in administration, health or behavioral science field preferred
  • Licensure / Certification: CMSC or CPCS preferred (National Association of Medical Staff Services)
  • Experience: Minimum of two years' experience in health related field performing credentialing activities
  • Must possess an in-depth knowledge of current Medicare coding and billing requirements. Must possess extensive knowledge of auditing concepts, principles and current medical terminology
  • Must possess strong written and verbal communication skills in order to communicate in clear, concise, terms to internal and external customers, including the ability to articulate complex regulatory information's in layman's terms
60

Credentialing Coordinator Resume Examples & Samples

  • Data Quality: Enters and maintains accurate practitioner data/information within the various credentialing databases ensuring all practitioner credentialing files contain the necessary documentation/verifications review standards. Reviews all expiable items and ensures that all practitioner's licenses, DEAs, insurance, certifications, and other expiable items are current, valid and renewed by the practitioner by their due date
  • Initial: Processes and oversees the initial applications for clinical privileges and medical staff membership. Processes temporary privilege requests. Processes applications for Educational Experiences. Ensures that all applications have been fully and accurately processed prior to the Clinical Council Chair's review. Maintains and tracks Cooperative Verification Services invoicing
  • Reappointments: Coordinates and processes the practitioner reappointment process and incorporates the review of quality management performance reports and data obtained during the Ongoing Professional Practice Evaluation (OPPE) into the reappointment process. Ensures all practitioners who are credentialed and privileged to provide patient care services within HealthEast Care System are appropriately reappointed within a two year time period. Processes requests for additional clinical privileges according to established policy and procedures. Monitors, reviews and revises Delineation of Privilege Forms on a biannual basis
  • General: Interacts and communicates with practitioners, clinical council chairs and with various levels of management as necessary regarding credentialing/application processing and practitioner information and communicates information appropriate for the intended audience
  • Performs analysis of supporting documentation ensuring that applications are processed according to established policies and procedures as well as the Medical Staff Bylaws and Rules & Regulations, within the established time frame. Researches and identifies problems/issues regarding data integrity and reports to the Credentialing Director and/or the appropriate medical staff leader(s)
  • Assists with accreditation and department of health surveys and attends survey interviews as needed
  • CPCS preferred
  • 2 to 6 years comprehensive credentialing experience in an acute care hospital setting or managed care organization preferred. Experience with Joint Commission, MN Department of Health and CMS survey processes. Experience working with medical professionals
  • Knowledge of health care environment, credentialing and medical staff organization. Knowledge of Joint Commission and Centers for Medicare/Medicaid Medical Staff Standards. Knowledge and skills in data collection, data analysis and interpreting results. Knowledge and understanding of clinical events
  • Computer Skills Advanced: Skilled in specialized computer software. Ability to use more advanced functions, formulas and other special elements of the specific program or application
  • Coordination: Integration of activities, structures, and responsibilities so that resources are used most effectively to meet objectives
  • Medical Terminology/Spelling: Familiar with medical terminology and medical spelling
  • Research: Ability to review and analyze relevant information from various sources to develop new information. Ability to identify primary and secondary authorities to validate the research
61

Credentialing Coordinator Resume Examples & Samples

  • Minimum of two (2) years’ credentialing experience in acute care, CVO (centralized verification organization), and/or managed care environment
  • Minimum of one (1) years’ experience in medical staff database management (Access or credentialing software)
  • CPCS (Certified Provider Credentialing Specialist) or CPMSM (Certified Professional Medical Services Management) or actively seek and obtain CPCS within two (2) years of hire into position
62

Credentialing Coordinator Resume Examples & Samples

  • Being responsible/the support for 100+ offices and their doctors in your region
  • Completing applications for several offices and doctors within your region
  • Regularly following up on renewals of dental licensure
  • Knowing and understanding different insurance plans, and Medicaids
  • Assisting offices and administration with EOBs, Claims, and other insurance related issues
63

GME Licensing & Credentialing Coordinator Resume Examples & Samples

  • Serves as Institutional Super-user for the New Innovations system at BIDMC, providing individual training to departmental users as needed; overseeing data entry, and problem-solving in collaboration with department program coordinators and managers
  • On behalf of BIDMC, interacts with Massachusetts Board of Registration in Medicine on all issues relative to limited license and renewal of license applications
  • Manages documentation, data, and follow-ups for licensure and certification standards
  • Assists in conducting data audits in New Innovations and Cactus programs, which serve as the basis for Medicare/Medicaid reimbursements to BIDMC
  • Designs and generates custom reports for the GME and Medical Center leadership relative to all aspects of house officer training requirements and Medicare reimbursement documentation (duty hour reports, current counts, etc.)
  • Attention to detail and demonstrated ability to follow through in all aspects of work
  • Strong interpersonal skills and ability to manage sensitive and confidential information
  • Ability to work independently, using judgment and flexibility in setting priorities and meeting multiple deadlines, and the ability to function as a reliable team member accountable to multiple customers