Credentialing Coordinator

Overview

Position Title:

Credentialing Coordinator
Department:
Medical Staff/Credentialing

Job Description:

Under general direction, initiates verification of initial and reappointment applications and coordinates and maintains medical staff databases for credentialing and verification needs.

• Oversees and initiates the entire credentialing and verification processes of OU Health staff for initial and reappointment applications to include standardized, cost-effective verification that comply with Joint Commission on Accreditation of Healthcare Organizations (TJC), National Committee for Quality Assurance (NCQA), Centers for Medicaid and Medicare (CMS), federal and state law.
• Analyzes verification information, including identifying red flag and/or adverse information and notifying Medical Staff leadership in accordance with policies & procedures.
• Monitoring of expiring information such as but not limited to DEA, license, professional liability insurance, and specialty board certification status; maintain and update credentials file(s).
• Compliant with department defined turn-around-times and key performance indicators.
• Timely, accurate, and complete database entries and maintenance of electronic files as required.
• Assists with the development and implementation of credentialing and recredentialing workflows to ensure efficient and effective alignment of processes including maintenance of delineation of privileges.
• Maintains a working knowledge of relevant regulatory standards (i.e., TJC and NCQA), state and federal requirements, and applicable Medical Staff Bylaws, rules and regulations.
• Assists with practitioner onboarding and orientation.
• Supports medical staff meetings.
• Participation in projects.

• Performs other duties as assigned.

Education: Associate s degree or higher

Experience: At least two (2) years of experience in a medical staff office, healthcare, legal, human resources or finance setting.

Licensure/Certification s/Registrations: Required:
Currently a Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) or willingness to achieve certification within 12 months of becoming eligible.

• Knowledge of accreditation standards and legal requirements related to medical staff organization
• Excellent verbal and written communication skills
• Ability to effectively communicate with key stakeholders and customers (i.e., medical staff leaders, hospital administration, practitioners, practice managers)
• Knowledge of credentialing software and associated applications strongly preferred
• Ability to work under minimal supervision and to adapt quickly to changes within the environment
• Ability to maintain confidentiality
• Ability to critically think and assess and determine appropriate next best steps in any given situation
• Proficient with the use of Microsoft Office tools

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OU Health is an equal opportunity employer. We offer a comprehensive benefits package, including PTO, 401(k), medical and dental plans, and many more. We know that a total benefits and compensation package, designed to meet your specific needs both inside and outside of the work environment, create peace of mind for you and your family.