Credentialing Coordinator Job Description
Credentialing Coordinator Duties & Responsibilities
To write an effective credentialing coordinator job description, begin by listing detailed duties, responsibilities and expectations. We have included credentialing coordinator job description templates that you can modify and use.
Sample responsibilities for this position include:
Credentialing Coordinator Qualifications
Qualifications for a job description may include education, certification, and experience.
Licensing or Certifications for Credentialing Coordinator
List any licenses or certifications required by the position: CPCS, CPMSM, NAMSS, GOLD, ECFMG, DEA, BEP/WBE/MBE, NEMT, CPMSC, CMSC
Education for Credentialing Coordinator
Typically a job would require a certain level of education.
Employers hiring for the credentialing coordinator job most commonly would prefer for their future employee to have a relevant degree such as Collage and Associate Degree in Education, Associates, General Education, Medical, Business, Healthcare, Health, High School Education, Health Care, Health Administration
Skills for Credentialing Coordinator
Desired skills for credentialing coordinator include:
Desired experience for credentialing coordinator includes:
Credentialing Coordinator Examples
Credentialing Coordinator Job Description
- Create, copy, file, and maintain all relevant documentation into provider credentialing folder
- Perform primary source verification on required elements and in accordance with policies and procedures
- Oversee data entry and upkeep of provider information in the credentialing database
- Verify competence, medical and/or professional education, residency, internships, fellowships, additional formal training, relevant board certifications, healthcare affiliations, work history, military experiences, professional references, licensure, certifications, malpractice coverage and privileges the applicant is requesting
- Query the American Medical Association (AMA), CertiFacts and National Practitioner Data Bank (NPDB) as appropriate
- Manage monthly expirables
- Attends Credentials Committee meeting, takes minutes and presents completed files to the Committee for recommendation of appointments, reappointments and change in privilege requests
- Manage both the Focused Professional Practice Evaluation (FPPE) and Ongoing Professional Practice Evaluation (OPPE) for the medical staff and allied health professionals
- Assists the PM&R physician advisor, manager and divisions regarding active medical staff appointments for initial appointments and reappointments
- Maintain and modify departmental database, integrating appointment, credentials, historical information, for all PM&R faculty and others
- Knowledge of medical credentialing, billing/collection practices
- Knowledge of insurance company operating procedures and practices
- Skill with computer applications
- Ability to courteously work with Physicians, hospital staff, insurance company representatives, coworkers and others
- Ability to interact professionally and collegially with referral sources (hospital & nursing home staff, physicians, social service workers, ), state contract officers, and coworkers
- Obtains credentialing information on all new CCF medical staff members
Credentialing Coordinator Job Description
- Adhering to established credentialing guidelines completes in-depth review and analysis of practitioner’s application and accompanying documents ensuring applicant meets facility guidelines and eligibility
- Attend and participate in all team related meetings
- Under direct supervision learns the credentialing and verification process
- Attend and participate in all team related meetings, work diligently to support company-wide and team goals
- Complete physician applications for the state medical licenses and hospital privileges
- Manage radiologist credentialing according to department policy and procedures
- Maintain physicians’ license expirations
- Conduct verification of credentialing elements through the use of system resources and approved departmental tools and document status within credentialing database(s)
- Files all information promptly
- Works with physicians to complete and obtain documentation
- Associate’s degree or equivalent preferred but not required
- Requires 1 -3 three years of experience in health care credentialing/ verification
- Excellent computer skills including Excel, Word, Database maintenance, and Internet use
- Minimum of one year credentialing experience required or equivalent combination of education and experience
- Good communication skills – written, telephone, and email
- Analyzes errors and traces back to the root cause using the raw data in the appropriate file or database as it relates to initial appointment and reappointment files, expirables
Credentialing Coordinator Job Description
- Ability to compile and maintain current and accurate data for all providers
- Ability to complete provider credentialing and recredentialing applications
- Ability to maintain copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers
- Knowledge of initiating and completing provider CAQH profiles
- Knowledge of current managed care plans and government requirements for credentialing providers
- Ensures practice addresses are current with health plans, agencies and other entities
- Tracks license, DEA and professional liability expirations, Nurse protocols and certifications for providers
- Prepares credentials file for completion and presentation to Central Verification Office, ensuring file completion within time periods specified
- Request facility site reviews from appropriate source
- Responsible for the generating, mailing, tracking, and subsequent processing of provider re-credentialing applications
- Must be able to communicate professionally with all providers
- Prior credentialing experience
- Ensures that appointments and reappointments to the Medical Staff and Advanced Practice Professionals (APP) are processed efficiently and in accordance with the Medical Staff Bylaws, APP Guidelines, and specific policies and procedures of the Medical Staff Credentialing Process
- 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
- After reapplication is received ensure it is complete
Credentialing Coordinator Job Description
- Prepares and distributes correspondence by Medical Board, Medical Staff Officers and Administration
- Ensures credentialing records are prepared for audits performed by managed care companies, Department of Health, Joint Commission, healthcare facilities, legal entities
- Creates credential files from initial information received from recruiting
- Researches and obtains verification of physicians' medical experience, professional references, state licensure, DEA, state narcotics, Evaluates data and determines suitability of match with EmCare clients
- Networks and coordinates the sharing, receipt, and/or update of information among various internal departments
- Coordinates with state licensure boards and physicians to obtain applications, documentation, and data necessary to obtain state licenses
- Collects and maintains all pertinent information from the provider
- Analyzes provider files for completeness, accuracy, consistency, gaps in work history, relevant references, Identifies issues and initiates further data collection as needed
- Updates and maintains physician CVs
- Completes initial and reappointments applications on all physician for local and outreach hospitals
- High school education, including one or two years additional in Business, English, Liberal Arts, or an aptitude in any of these fields
- Minimum of two to three years of credentialing experience at a health plan, medical group or hospital strongly desired or transferable job skills in government provider enrollment
- Must be comfortable speaking with all levels of management
- Must have an Associates degree in a health or business related field
- Requires training and proficiency in the use of Microsoft Word and report writing computer programs
- Prior experience in medical staff credentialing desirable
Credentialing Coordinator Job Description
- Executes the Medical Staff and Allied Health privileging process in accordance with the MHMH Medical Staff Bylaws, Rules and Regulations, policies and procedures and in accordance with guidelines of all Regulatory bodies including the TJC and the appropriate states
- Completes initial credentialing and re-credentialing applications on all physicians for managed care companies
- Ensures all physicians’ licensure, DEA and DPS certificates are current
- Ensures all physician extenders’ licensure and certificates are current
- Obtains credentials for all physician extenders with each hospital at which their sponsors have privileges
- Ensures CME hours meet licensure requirements
- Assists Business Office staff as needed
- Processes provider applications and re-applications
- Advanced computer skills (MS Office Suite’s Word, Access, Excel, & Outlook
- Assists in developing and implementing short and long-term work plans and objectives
- Bachelor's Degree preferred or at least (3) years of experience directly related to hospital credentialing
- Excellent telephone and organizational skills are essential
- Certification as a Certified Professional Credentialing Specialist (CPCS by the National Association of Medical Staff Services (NAMSS) desirable
- Requires initiative and organizational ability
- Uses good judgment and critical thinking skills
- Oversees the process to prepare Clinic and Center Managers to onboard new physicians