Credentialing Coordinator - Show Low, United States - Summit Healthcare Regional Medical Center

Description

The Coordinator is responsible for preparing and submitting credentialing applications and supporting documentation for the purpose of medical staff and allied health professional credentialing and health plan credentialing.

• Monitor and maintain practitioner medical staff and health plan credentialing expirables.
• Maintains practitioner credentialing files electronically via MDStaff, practitioner enrollment software, shared computer files, and CAQH (Council for Affordable Quality Healthcare)
• Successfully implements the entire enrollment and health plan credentialing and recredentialing process for the organization (practitioners and entities). Coordinator must maintain timelines on enrollment/credentialing schedules, communicate with practitioners and other departments to update information as needed, clarify carrier information requirements, and maintain a strict level of confidentiality for all matters pertaining to practitioner credentials.
• Updates and distributes medical staff roster, provider contact preference list, provider office phone list.
• Maintains confidential credentials, files, and electronic medical staff database.
• Maintains and updates health plan rosters.
• Responds to correspondence both internally and externally.
• Interfaces regularly with internal staff and acts as a Summit liaison for practitioners and health plans related to the credentialing process.
• Manages, coordinates, and monitors all aspects of the initial appointment, provisional appointment and reappointment and privileging process for both medical staff and health plan credentialing to ensure accurate and timely credentialing for prospective members of the medical staff.
• Prepares and disseminates notices of final action on applications, new privileges, provisional reviews, reappointments, and changes in staff status; Update and maintain clinical privileges on the hospital-wide system.
• Facilitates Medical Staff compliance with regulatory requirements for hospital accreditation to include, but not limited to,National Committee for Quality Assurance (NCQA), Det Norske Veritas Germanischer Lloyd (DNV GL),and Centers for Medicare & Medicaid (CMS).
• Updates all PLIID (Practitioner, Location, Insurance ID) entries i.e. practitioner and PTAN numbers once practitioner enrollment process is completed.
• Establish professional relationship with health plan contacts to ensure information is being updated correctly and in a timely manner.
• Assist the Business Office and SHMA Practice Management with resolution of health plan demographic error corrections/updates.
• Assist with any outstanding/pending credentialing related issues.
• Provide weekly status report on on-going projects.

• Cross-trains with other Coordinators in department providing coverage/assistance as needed.
• Works as a 'float' between medical staff and health plan credentialing as volumes dictate need for additional assistance.
• Responsible for security and maintenance of all credentials files.
• Participates in departmental and hospitalwide informational meetings and inservices, including staff meetings, hospitalwide forums, and seminars.
• Continuously evaluates, proposes, and implements medical staff services procedures to standardize and ensure for accuracy and completeness. Ensures compliance with State and Federal requirements and Accreditation standards; interprets, explains, and follows all regulatory guidelines and Federal and State laws and regulations.
• Works cooperatively with others for Medical Staff Development and Recruitment.
• Assists with monitoring and revising credentialing and privileging forms as needed.
• Reviews department and hospitalwide policies and procedures annually.
• Participates in the budget planning process and provides input and data collection.
• All other duties as assigned.

• Processes initial Locum Tenens applications in an expedited time period to meet coverage needs.
• Prepares meeting agenda/materials, attends meetings, and records/distributes minutes from various meetings as needed.

• Recurring work situations with occasional variations from the norm.
• A high degree of complexity and confidentiality.
• Typical operation from established and well-known procedures;
• Assist with developing new policies, processes, practices, programs, etc.
• Performance under independently-minimal supervision.

• None.

• Are normally made with others both inside and outside the hospital.
• Are usually made with own department as well as other departments or locations.
• Frequently contain confidential/sensitive information necessitating discretion at all times.
• Are made via telephone, e-mail, and face-to-face interaction.
• Are normally with physicians and other health plans, staff and practitioners.

This position requires operational knowledge of all equipment in the Administration area, including: fax, printers, copy machine, binding machine, phone systems, overhead projector, and computer programs (including MDStaff, BoardEffect, MS Office, e-mail, internet, and all Hospital Information Systems).

This employee must be service oriented and have excellent customer service skills, written and oral communication skills, computer skills, organizational skills, multitasking skills, professional interpersonal skills, time management skills, the ability to prioritize work, and telephone etiquette.