CREDENTIALING COORDINATOR

• Tampa, FL
• Remote
• Medical Staff Services
• Full Time - Day Shift - 8-4:30pm or 7:30 - 4pm
• Req #: 90287
Posted: Yesterday -->

At Moffitt Cancer Center, we strive to be the leader in understanding the complexity of cancer and applying these insights to contribute to the prevention and cure of cancer. Our diverse team of over 9,000 are dedicated to serving our patients and creating a workspace where every individual is recognized and appreciated. For this reason, Moffitt has been recognized on the 2023 Forbes list of America’s Best Large Employers and America’s Best Employers for Women, Computerworld magazine’s list of 100 Best Places to Work in Information Technology, DiversityInc Top Hospitals & Health Systems and continually named one of the Tampa Bay Time’s Top Workplace. Additionally, Moffitt is proud to have earned the prestigious Magnet® designation in recognition of its nursing excellence. Moffitt is a National Cancer Institute-designated Comprehensive Cancer Center based in Florida, and the leading cancer hospital in both Florida and the Southeast. We are a top 10 nationally ranked cancer center by Newsweek and have been nationally ranked by U.S. News & World Report since 1999.
Working at Moffitt is both a career and a mission: to contribute to the prevention and cure of cancer. Join our committed team and help shape the future we envision.

Summary

Credentialing Coordinator

Position Highlights:

• The Credentialing Coordinator, independently leads the credentialing and the privileging of each individual practitioners applying for Medical Staff Appointment and Membership and ensures compliance with Medical Staff Bylaws, The Joint Commission (TJC) Medical Staff standards, National Commission on Quality Assurance (NCQA) standards, State regulations and Conditions of Medicare Standards (CMS) and Utilization Review Accreditation Commission (URAC) as applicable and related to medical staff credentialing and privileging. The coordinator conducts an in-depth review and analysis of the providers’ application, qualifications, training, experience and accompanying documentation. The coordinator leads all duties related to the Managed Care credentialing/re-credentialing process and Health Plan enrollment.

Responsibilities:

• Independently leads the credentialing, re-credentialing and privileging of each individual practitioner applying for initial appointment or reappointment and ensures compliance with Bylaws and accreditation standards. Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow-up
• Implements the provider enrollment for third party payors, ensuring compliance with delegated credentialing standards.
• Analyzes and determines the clinical privileging criteria. Ensures the accuracy of the clinical privileging data and information.
• Analyzes the delineation of clinical privileges, summarizes data and proposes solutions to problems encountered.
• Facilitates Focused Professional Practice Evaluations (FPPE) and analyzes for further action.
• Summarizes the Ongoing Professional Practice Evaluations (OPPE).
• Ensures compliance of provider credentials.
• Facilitates monthly and quarterly queries.
• Participates in establishing and implementing credentialing guidelines and departmental policies and procedures.
• Attends and assists in various Medical Staff and departmental meetings.
• Prepares Managed Care audits and summarizes findings in a clear manner.

Credentialing and Experience:

• Associate’s degree in a related field
• Three (3) years' relevant experience in an office, academic or healthcare setting is required.
• Experience in hospital and or managed care credentialing preferred.
  • In lieu of an associate’s degree, applicants with a high school diploma or equivalent with minimum five (5) years' relevant experience will be considered