Full-Time
Credentialing Coordinator
University of Rochester
Private research university in Rochester, NY
Compensation Overview
$23.27 - $32.60/hr
Rochester, NY, USA
Remote
Associate's
Category
 Legal & Compliance (1) |
|---|
Required Skills
Microsoft Office
Word/Pages/Docs
Excel/Numbers/Sheets
PowerPoint/Keynote/Slides
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Requirements
- An Associate's degree in business or a healthcare-related field and two years of medical administrative experience are required, or an equivalent combination of education and experience.
- Fluent English language skills, both oral and written, are required.
- Proficiency in Microsoft Office, including Word, Excel, and PowerPoint, email, and the internet is required.
Responsibilities
- Participate in departmental activities to ensure quality in conducting, maintaining, and communicating the medical and allied health professional staff credentialing, privileging, and primary source verification process.
- Determine practitioner eligibility for membership or participation.
- Analyze applications and supporting documents for accuracy and completeness, and inform practitioners of application status, including any need for additional information or corrections.
- Obtain, research, and evaluate primary-source information to validate application accuracy and ensure compliance with accreditation and regulatory standards, including education and training, licensure, work history, hospital affiliation history, malpractice claims history, board certification status, criminal background, health status, and peer recommendations.
- Recognize, investigate, and validate discrepancies and adverse information obtained during the application process so review and approval bodies have the information needed to make informed credentialing decisions.
- Process requests for privileges when applicable, ensuring compliance with criteria in clinical privilege descriptions.
- Monitor initial and reappointment processes for Medical and Allied Health Professional staff to ensure timely processing, regulatory compliance, required primary-source verifications, and complete documentation.
- Monitor completed files through departmental and committee review until final approval to ensure compliance with regulatory standards.
- Monitor personal accuracy and productivity statistics and communicate questions, concerns, or training needs to managers.
- Review performance measures and goals regularly with auditors and management.
- Collaborate and coordinate activities with Credentialing Managers and staff.
- Collaborate with the Compliance, Dean's, Health, and Legal offices and other stakeholders to ensure policies and standards are met.
- Communicate applicant-file status directly to providers, department representatives, clients, and affiliates, and coordinate efforts to obtain necessary information and documentation to meet deadlines.
- Communicate the status of expiring credentials, including licenses, Drug Enforcement Administration credentials, health reviews, PPD, infection control, and specialty privilege requirements, and coordinate efforts to obtain required information and documentation.
- Serve as a resource for departments and clients regarding medical staff bylaws, policies, and procedures.
- Respond to inquiries from healthcare organizations and interface with internal and external customers regarding day-to-day credentialing and privileging issues.
- Review and assess departmental functions and services with management to identify improvement areas and implement changes as needed.
- Assist with credentialing expirables, including annual health requirements, licenses, Drug Enforcement Administration credentials, malpractice coverage, and board certification status.
- Represent the Medical Staff Services Department in initiatives and committee meetings as needed.
- Serve as backup to other credentialing staff as needed.
- Serve as a team peer interviewer as needed.
- Perform other duties as assigned.
Desired Qualifications
- One year of medical credentialing and/or payer enrollment experience is preferred.
- Knowledge of and experience with Joint Commission, Centers for Medicare & Medicaid Services, and National Committee for Quality Assurance regulations related to medical staff services and commercial payer credentialing is preferred.
- Knowledge of and experience with database applications is preferred.
- Exceptional interpersonal and communication skills are preferred.
- Ability to develop and maintain relationships with a variety of key stakeholders across the organization is preferred.
- Certified Medical Professional Services Management certification upon hire is preferred.
- Certified Provider Credentialing Specialist certification upon hire is preferred.
The University of Rochester is a research university with programs spanning the humanities, health care, business, education, music, engineering, and the sciences.
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