Credentialing Coordinator
Job Description
Location: Steward Health Care Network
Posted Date: 5/24/2023
Position Purpose:
Reporting to the Credentialing Supervisor, the Credentialing Coordinator facilitates the accurate and efficient Credentialing and Recredentialing of Steard Health Care Network providers in alignment with State, Federal, and NCQA standards.
Key Responsibilities:
- Responsible for ensuring timely processing credentialing, recredentialing, practitioner files, organizational files and the credentialing database, and coordination of the Credentialing Committee meeting including meeting minutes for reporting to the Quality Improvement Committee as needed. Conduct internal and external validation of credentialing file audits, and address identified issues in a timely manner.
- Facilitate prompt coordination with the Credentialing Verification Organization (CVO) and monitor Work in Progress (WIP) file, promptly addressing incoming files for processing. Review and maintain all applications for accuracy and completeness, ensure primary source verification, and overall processing time frames are met. Generate forms, letters, checklists, and maintain the internal tracking database/data entry, ensuring complete and accurate data entry.
- Contribute toward the coordination of the Credentialing Committee by accurate and complete preparation of credentialing and recredentialing files. Identify and communicate agenda items to the Credentialing Director to be addressed at the Credentialing Committee. Facilitate preparation of files for electronic storage. Assist in updating the database to reflect Credentialing Committee decisions.
- Coordinate with Network Services or other sources as necessary on follow-up items needed to complete the credentialing process. Communicate to Network (or other internal departments) regarding status of provider and organizational credentialing.
- Maintain ongoing participation in cross-training activities. Actively engage in addressing special projects as they arise, conducting preliminary research and follow-up, and tracking/monitoring to facilitate ongoing reporting of project status. Provide recommendations and feedback regarding development of process improvements and/or standardization practices. Other duties as assigned.
Education:
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Application Instructions
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Apply OnlinePosted: 5/24/2023
Job Status: Full Time
Job Reference #: 130680