The Credentialing Coordinator serves as the first line of defense in Health Plan Quality through the functions of providing for adequate and qualified Medical Staff. Under supervision of the Credentialing Manager, the Credentialing Coordinator is responsible for the all aspects of the Credentialing process. Duties include ensuring that the health plan and its providers comply with regulatory and accrediting agencies, interpreting standards, and identifying, recommending and implementing changes. This position serves as the liaison between the plan administration and the medical staff on matters such as credentialing. This includes, but is not limited to, verification of education and training; certification and clinical practice submitted by physicians and allied health professionals. The Medical Staff Credentialing Coordinator demonstrates leadership through the role of advisor to the medical staff and administration in understanding and applying the standards that the medical staff must meet. This position is responsible for developing and maintaining all aspects of the credentialing function, including credentialing practitioners, facilities, and ancillary services both for initial appointment and re-appointment. The Medical Staff Credentialing Coordinator guides health plan leadership and medical staff through such functions such as credentials committee meetings. The Medical Staff Credentialing Coordinator is able to advise the medical staff leadership on matters of priority in an expeditious manner and can instruct them in the responsibilities of their positions with respect to credentialing and help bring them up to date on current issues involving regulatory agencies, clinical privileges, and standards of care. The Credentialing Coordinator should demonstrate strong organizational skills and assertiveness in problem solving.
MAJOR RESPONSIBILITIES * Responsible for all aspects of Credentialing of Institutional and Individual Providers. * Preceptor to others in duties related to Credentialing. * Cross-trains other staff for major job responsibilities as appropriate for optimum functioning. * Serves as liaison between the medical staff and plan administration. * Oversees medical staff credentialing activities during initial appointment. * Oversees medical staff credentialing activities during re-appointment. * Precepts and mentors designated medical staff personnel. * Coordinates medical staff with regulators. * Assist with facilitation of Medical Staff meetings. * Responsible for all phases of preparation for Medical Staff Credentialing meetings, including production of agenda, documents for review and for personal review and preparation of medical staff in advance as needed to facilitate informed participation. * Responsible for accurate and timely recording of minutes of all Medical Staff Credentialing meetings. * Assists medical staff in enforcing medical staff bylaws, rules and regulations, policies and procedures, and identifies /communicates the need for revisions and additions as needed. * Tracks, on an on-going basis current licensure required for physicians and allied health professionals. * Records and tracks medical staff meeting attendance, as required by medical staff bylaws for maintaining staff status * Provides support for medical staff and Plan Administration for Due Process Proceedings by attending hearings and appeals meetings and recording proceedings * Tracks monitoring/proctoring documentation necessary for the granting of special or new privileges to physicians. * Assists with coordination of collection of information for additional review for any applicant whose initial or recredentialing process reveals factors that may impact on the quality of care or services delivered to consumers. * Updates on a daily basis the physician/AHP data base for the credentials database, and keeps current Medical Staff Services Department credentialing computer system. * Follows the CHRISTUS Guidelines related to the Health Insurance Portability and Protected Health Information ACT (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI). * Collaborate with all other departments as appropriate and required to facilitate the completion of tasks/goals. * Active participant in health plan's compliance with the standards of URAC Credentialing Accreditation. * Communication, Coordination, Collaboration with all customers, internal and external * Assists Quality Management Department with special projects. * Serves as liaison to medical staff in matters of credentialing and related issues. * Manages projects and timelines to achieve highest quality work within allotted period.
Some college or 4-6 years executive secretarial or healthcare management experience, or prior Medical Staff Coordinator experience preferably in a hospital or healthcare plan environment
Must possess organizational skills necessary to manage the credentialing office, coordinate activities of the medical staff, and provide follow-up documentation
Attention to detail, ability to prioritize, good judgment, excellent customer service and computer literacy skills a must
Proficiency in Word Processing and Spreadsheet applications
Ability to meet deadlines in high pressure environment
Able to withstand intense interpersonal interaction
Confidentiality and compliance with healthcare regulations affecting special privileges afforded the Medical Staff with regards to the protected and confidential nature of Medical Staff Proceedings.
Considerable independent discretionary capacity related to interpretation and application of state and federal regulations.
Must be able to work independently 80-95% of time.
Ability to sit for long periods of time.
Ability to organize and prioritize work to meet deadlines.
Ability to work occasional long or irregular hours.
Good speaking ability, judgment, and initiative
Minimum two years prior experience as a Medical Staff Coordinator or equivalent position
Prior experience as Credentialing Coordinator in a health plan preferred
Certified Professional Medical Staff Credentialing or CPCS preferred
CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.