The Credentialing Coordinator is responsible for assuring that the credentialing of practitioners is conducted in accordance with the Office of Integrated Credentialing/client policies and procedures, entity bylaws/credentialing plan, regulatory agencies, and accrediting bodies. The Credentialing Coordinator performs quality control audits and coordinates the preparation of completed practitioner files, maintains accurate records regarding the processing status of each practitioner, and flags potentially adverse information. The Credentialing Coordinator is responsible for assuring all activities are conducted as scheduled and per departmental standards.

Essential Duties:

• Processes initial credentialing and reappointment applications, reviews for completeness, verifies information through appropriate resources, and processes the applications to Integrated Credentials Committee, as applicable, in a timely manner and as defined in Credentialing Policies and the Medical Staff Bylaws/relevant Credentialing Plan.
• Review all returned application materials for appropriateness and completeness, insure that documentation of all training and experience for requested privileges is provided and maintain an on-going dialogue with the applicant and other interested parties to assure that applicants are credentialed by their start/reappointment date.
• Follow up with client Medical Staff Offices, Departments, clients, practitioners and other respondents regarding incomplete/missing information on documents received according to OIC procedures.
• Maintains paper/electronic credentials files, clinical privilege forms (as assigned) and practitioner databases to insure information contained is accurate and current. Effectively utilizes all software systems to perform essential job functions, adhering to established data entry conventions.
• Perform electronic, written and telephonic queries to agencies providing primary source information regarding malpractice claims, licenses, certifications, training and affiliations. Assess content of responses to determine any follow up required.
• Processes reappointment/credentialing applications including gathering OPPE and other quality data, verification of all required elements in accordance with Credentialing Policies and Medical Staff Bylaws, Rules and Regulations, and relevant Credentialing Plan and submitting to appropriate Department Chairs/Chief/designees and committees for review.
• Monitor receipt of credentialing information and insure that second and third requests are sent within the defined time frame.
• Review all application documents and responses for appropriateness and completeness, insure that documentation of all training and experience for requested privileges is provided
• Evaluate the completeness and integrity of initial applicant, reappointment applicant, and annual evaluation files, and determine when all necessary verificatons and required documents have been completed and are present for appropriate chair/chief/designee and committee review.
• Work closely with the supervisor in identification of reappointment names and dates
• Independently make decisions regarding whether information meets OIC, TJC, NCQA, DNV, Title 22, and CMS and relevant bylaws/Credentialing Plan requirements related to content, completeness and timeliness.
• Ensures maximum confidentiality, accuracy, security, and appropriate access of all data and records, and provides maximum protection from discoverability of all information.
• Responsible for obtaining approval signatures on applications and delineation of privileges forms prior to presentation at relevant Integrated Credentials Committee, as applicable
• Prepare completed, accurate practitioner credentials files for delivery to clients.
• Participates in facility/credentialing preparation for site visits and licensing/accreditation surveys
• Participate in preparation for and support of internal and external audits of OIC processed files
• Inform the supervisor of quality and practitioner credentialing issues of concern on a regular and timely basis. Flags potentially adverse information through analysis of application and verifications for competency/care concerns and brings forward to supervisor’s attention.
• EXPIRABLES MANAGEMENT, as required. Responsible for managing the expiring documents process prior to updating the provider database. Verifies current license, malpractice insurance, DEA, board certification, and other applicable certifications, as required. Contact practitioner prior to expiration of doucments, notified department coordinator/administrator and/or facilities of pending expiriations Process includes accurate data entry and image scanning. Sends notifications of provider expired credentials to OIC supervisor, medical staff clients, hospital departments, provider’s department coordinatore, provider’s chair/chief
• ONGOING MONITORING, as required Reviews all applicable State Licensing Board Reports (all boards for which we have credentialed providers) monthly to determine whether any unfavorable actions were taken, including but not limited to Medical Board of CA, Osteopathic Medical Board, Dental Board of CA, Board of Registered Nursing, Board of Pharmacy, Clinical Psychology, Physical Therapy Board, Occupational Therapy Board, etc. Notifies supervisor of any Red Flag reports identified. Prints hard copies of Red Flag Information. Maintains electronic and/or paper copies of State Licensing Board Reports each month for future review and reference. Reviews OIG, EPLS and Palmetto reports on a monthly basis and maintains copies of the reports for future review and reference. Notifies supervisor of any Red Flag reports.
• INITIAL APPLICATION AND REAPPOINTMENT APPLICATION DISSEMINATION, as required Processes requests for initial applications from clinical departments. Sends out reappointment application packets 6 months in advance of reappointment date.
• OTHER, as required Answer all incoming calls in a timely manner, provides courteous and professional phone support Office Maintenance - Orders and maintains office supplies; coordinates care and maintenance of departmental space and equipment. Stores old files, scans, and destroys confidential documents according to departmental policies. Provides and maintains a file system that allows for easy retrieval of information. Works collaboratively in dissemination of provider data across the enterprise and externally as needed, including, but not limited to: IT, Quality & Outcomes, Compliance, Pharmacy, Call Center, HIM etc. Meeting Scheduling - Coordinates meeting dates and times with all participants. Arranges for conference rooms or other meeting locations, audio-visual equipment, or catering services as needed.
• Completion of User Provisioning forms that are forwarded to IT for USC Care approved initial applicants, as applicable.
• Attends and participates in new practitioner/resident orientation events with OIC supervisor, as requested.
• Performs other duties as assigned.

Required Qualifications:

• High school or equivalent

• Knowledge of Joint Commission, DNV, AAHC, and NCQA standards, Title 22, and CMS regulations pertaining to the organized medical staff, preferred
• Knowledge of medical staff principles, practices, quality assessment, performance improvement functions, and legal concepts related to the organized medical staff, preferred

Preferred Qualifications

• Bachelor's degree in related field
• 5 years Five years’ experience as a credentialing professional preferred
• Experience in medical group credentialing/provider enrollment.
• Hospital or multi-entity credentialing experience.
• Certified Professional in Medical Services Management (NAMSS) Valid CPMSM or CPCS certification by the National Association of Medical Staff Services strongly preferred

Required Licenses/Certifications:

• Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)