CREDENTIALING COORD.

Job Summary:

Coordinate and perform functions related to medical and allied health professional staff credentialing, reappointment, and privileging. Assures credentialing, reappointment, and privileging is completed in accordance with the Centro San Vicente Staff Bylaws, policies and procedures, Joint Commission and federal and state standards/requirements.

Essential Functions:

• Processes credentialing and re-credentialing applications of LIP and non LIP. Reviews applications, prepares verification letters, track responses, and follows-up for needed information.
• Performs credentialing functions to query licensure, DEA/CSR, Board certifications and education.
• Conducts/assists with investigation of adverse or missing information.
• Reviews credentials and reports to the Credentialing Committee.
• Produces regularly scheduled and ad hoc reports.
• Maintains agenda and minutes for the Credentialing Committee.
• Maintains credentialing database by entering accurate and up-to-date data for each
  applicant into the database and sends reminders to providers and managers for renewals. Responsible for the accuracy and integrity of the data entered.
• Maintains MCO contract database and reviews contracts with the Contracting Committee on a regular and/or as needed basis.
• Completes and executes MCO contracts with new and existing companies.
• Reviews managed care contracts for credentialing requirements.
• Conducts background investigations on practitioners in accordance with Joint Commission and TDI credentialing standards and other established principles of legal documentation and confidentiality.
• Coordinates correspondence including confidential documents.
• Maintains integrity, confidentiality, up to date and accuracy of computer records and documentation concerning applications, credentialing information, and related criteria.
• Maintains reports on credentialing.
• Communicates and prepares correspondence to providers concerning results of application and re-credentialing review.
• Advises Business Office regarding approved enrollments of providers to managed care plans.
• Performs random audits of files from verification source.
• Participates in Plan audits by outside regulators or designated agency.
• Prepares files and documentation for timely presentation and review by the Medical Director and the Credentialing Committee.
• Maintains knowledge of accrediting bodies' requirements and recommend best practices.
• Communicates and demonstrates the mission, vision and values of the center.
• Process healthcare Students asking for preceptorship.
• Process healthcare Volunteers and/or Contractors.
• Performs other related duties as assigned.

Knowledge, Skills and Abilities:

• Computer literate in word processing and database software.
• Organized and able to multi-task
• Knowledge of regulatory requirement, including state, federal and JCAHO regulations.
• Knowledge of federal and state employment laws pertaining to employment and HIPAA.
• Ability to communicate effectively both verbally and in writing.
• Excellent interpersonal skills.
• Ability to work in a team environment.

Minimum Qualifications:

• Associate’s degree in Health Administration, Medical Staff Services or closely related field.
• Two (2) years of responsible, related experience; or
• High School diploma (or GED) and related experience to equal five (5) years.