Credentialing Coordinator in Remote at Family Health Center

The Credentialing Coordinator directs and facilitates completion of credentialing and re-credentialing of healthcare providers and staff per organizational policies and HRSA regulations. The Credentialing Coordinator will assist with onsite visits to review credentialing files per the accrediting bodies and organizational standards. The Credentialing Coordinator is the main resource on credentialing polices and provides administrative support for maintaining credentialing documents and provider data in the compliance operating system.

ESSENTIAL JOB FUNCTIONS

1. Completes health care professionals’ credentialing and re-credentialing appointments.
2. Maintains working knowledge of Health Resources and Services Administration (HRSA) standards.
3. Performs and collects PSV (primary source verification) documentation for licensing, board certifications, proof of professional liability insurance, National Practitioner Data Bank (NPDB) and/or other sources required based on HRSA standards, health plan requirements, and company credentialing policies.
4. Maintains a credentialing database/spreadsheet to ensure up-to-date information is obtained at all times. Maintains provider and staff credentialing folders and updates necessary information in compliance operating system to ensure timely reminders are sent to providers, staff, and management prior to expiry.
5. Responsible for monitoring and managing credentialing/re-credentialing requirements and to ensure the collections of all required renewal certifications are on file within the required time frame.
6. Prepares and uploads credentialing/re-credentialing files and other credentialing documentation in provider folders.
7. Answer credentialing questions and provider to providers, staff, and department managers as necessary.
8. Process provider/staff terminations, specialty/category changes, and leave of absence requests.
9. Audit disciplinary reports, OIG reports, and other requirements as required.
10. Assist with credentialing audits and Health Resources and Services Administration (HRSA) audits/site visits.
11. Develops, implements, and reviews credentialing policies and procedures to ensure the information is current and in compliance.
12. Attends credentialing committee meetings as requested.
13. Other duties as assigned.

KNOWLEDGE / SKILLS / ABILITIES

1. High school diploma or equivalent plus one year experience in credentialing or administrative assistance; or
2. Associates degree in healthcare management or related field and six months experience in credentialing or administrative assistance