Credentialing Coordinator

Credentialing Coordinator

Hours:

Shift Start Time: 7:30 AM

Shift End Time: 4 PM

AWS Hours Requirement: 8/40 - 8 Hour Shift

Additional Shift Information:

Weekend Requirements: No Weekends

On-Call Required: No

Hourly Pay Range (Minimum - Midpoint - Maximum): $32.730 - $40.910 - $45.810

The stated pay scale reflects the range that Sharp reasonably expects to pay for this position. The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant's years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices.

What You Will Do

The Credentialing Coordinator is responsible for the credentialing, re-credentialing, primary source verification, and ongoing monitoring of providers affiliated with Sharp HealthCare in accordance with applicable accreditation standards, regulatory requirements, policies, and bylaws. This position serves as a resource on credentialing processes and requirements for the Sharp hospitals, medical groups, and health plan. The Credentialing Coordinator is a steward of complete and accurate provider data in the applicable systems and the supporting processes to advance the quality of practitioners and patient safety at Sharp facilities.

Required Qualifications

• H.S. Diploma or Equivalent
• 3 Years experience in hospital and/or healthcare credentialing.

Preferred Qualifications

• Bachelor's Degree or equivalent work experience.
• Certified Provider Credentialing Specialist (CPCS) - National Association Medical Staff Services -PREFERRED
• Certified Professional Medical Services Management (CPMSM) - National Association Medical Staff Services -PREFERRED

Essential Functions

• Credentialing Performs primary source verification of all required credentialing data elements for the initial and recredentialing processes in compliance with state and federal legislation and accreditation standards. Responsible for maintaining timely, complete, accurate credentialing files, in electronic format, for assigned provider files. Analyzes submitted applications for completeness and required documentation to identify missing data elements and time gaps. Conducts follow-up with applicant on identified adverse elements. Investigates, as necessary, through to final resolution. Examines and evaluates verification results by cross-referencing to information reported on application and curriculum vitae. Analyzes materials for compliance with qualifications and criteria. Investigates discrepancies and misstatements with applicant and other primary sources, as necessary, through to final resolution. Identifies key issues in core credentials data. Recognizes and reports adverse information and unresolved questions to department Leadership and/or Credentialing Clients, as appropriate. Maintains accurate and current credentials in the credentialing database for all applicants. Adds/updates all credentialing information upon receipt. Monitors and tracks application status through the credentials process, performing routine follow-up as outlined in department policy. Records clear notes of attempts to obtain verifications for transparency to Credentialing Clients and backups, when applicable, to determine status of application process. Responds to all internal and external customers via email or phone in a timely fashion to uphold a high level of customer service. Expresses thoughts clearly, concisely, and effectively both verbally and in writing. Ensures a free flow of information and communication, by actively listening and welcoming feedback to foster a safe environment. Performs all essential functions in accordance with established procedures to consistently meet key performance indicators.
• Process Improvement Utilizes a continuous quality improvement approach to identify and initiate process improvements to maximize department efficiency, effectiveness, and productivity in daily work activities. Supports departmental operations through active engagement in huddles, assigned meetings, and ongoing performance improvement. Contributes to the planning, development and implementation of initiatives and automation. Ability to adapt behavior in response to new information or changing circumstances. Is open to change and new information, ideas, methods, or approaches to contribute to the department’s vision.
• Regulatory Responsibilities Maintains current knowledge of and continuous compliance with applicable accreditation standards, state and federal regulatory requirements, policies, and bylaws. Participates in credentialing training sessions offered by the department, i.e. webinars, podcasts, articles, etc. to stay abreast of changing standards and regulation. Participates in the development of and adherence to processes, policies, and procedures that support reliable departmental work product. Applies knowledge and independently consults available resources, as necessary, to troubleshoot issues and resolve barriers.

Knowledge, Skills, and Abilities

• Database management proficiency required; data entry skills required.
• Detail-oriented, and, understands data system organization. Possess strong computational and data analytical skills.
• Customer service oriented; able to interact with physician leadership, staff, and external organizations, including health plans, regulatory agencies, and licensing boards.
• Strong communication skills (both written and verbal). Ability to exercise independent critical-thinking and problem-solving skills.
• Demonstrates a high level of confidentiality and maintains data integrity.
• Ability to independently manage workflow, set priorities, and develop goals and strategies to achieve them. Aligns communication, ideas, processes, and resources to drive success.

Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class.