Description

OVERVIEW

Advanced Diagnostics Healthcare System is an independent, physician-led and patient-centered organization of hospitals, clinics and diagnostic centers in Texas. We are entirely focused on bringing you advanced, comprehensive care and superior patient experience. As we continue to grow, our focus is providing quality patient care by adding to our team of clinical and non-clinical professionals that work together in a collaborative manner.

JOB SUMMARY

This position is responsible for supporting and coordinating all provider and physician credentialing activities. The Credentialing Coordinator verifies that all policies and procedures associated with credentialing meets external accreditation, state regulatory requirements, and organizational requirements.

The Credentialing Specialist in this role verifies the professional licensing, training, and certifications as well as maintaining the credentialing & re-credentialing process of the professional medical staff. The primary goal is to ensure healthcare professionals and services meet all established federal and state standards.

DUTIES AND RESPONSIBILITIES

• Conducts credentialing and re-credentialing related activities.
• Monitors and maintains credentialing databases and files for practitioners and providers.
• Facilitates applications and re-applications for providers per company and state requirements.
• Communicates with providers in a timely manner regarding status of credentialing via written or verbal communication.
• Maintains additions, changes, and terminations in credentialing database.
• Maintain copies of current state license, DEA certificates, malpractice coverage and all required documents.
• Maintain facility appointment files an information.
• May facilitate new provider orientation and onboarding.
• May manage policies and procedures associated with provider credentialing.
• Conducts credentialing audits and satisfaction surveys.
• Maintain effective working relationship with provider, all management levels, staff and external.
• Effectively communicates with all stakeholders.
• Continuous compliance with HIPPA regulations and Compliance/Program Integrity requirements.
• Performs other duties as assigned.

Qualifications

• Three (3) years of credentialing, database management preferred or medical staff coordination in managed or acute care environment.

EDUCATION

• Associates Degree in related field or equivalent experience in lieu of degree.

CERTIFICATION, LICENSURE

• N/A

KNOWLEDGE SKILLS & ABILITIES

• Knowledgeable of NCQA, URAC, and Joint Commission standards and requirements of accreditation.
• Proficiency (intermediate) with MS Office software, Word, Excel.
• Demonstrated effective written and oral communication skills.
• Effective attention to detail, good organization skills and the ability to meet deadlines and requests utilizing appropriate time management skills.