Coordinator, Credentialing Quality & Delegation - Legal - Full Time

Job-ID: 25934Category: Admin Support/ClericalLocation: Binghamton, NY, United StatesSchedule: Full timePosted: 2026-11-03As a Credentialing Quality & Delegation Coordinator, you'll play a key role in system wide compliance. From coordinating with Joint Commission, State Regulations and Bylaws your partnership will ensure compliance with regulatory standards, your attention to detail will show support in many ways. If you thrive in a fast-paced environment and enjoy being the organizational backbone of a dedicated healthcare team, this is your opportunity to make a meaningful impact.Recognized as a Top Healthcare EmployerGuthrie is consistently recognized for its strong workplace culture and commitment to caregiver well-being, including:Best Places to Work 2025 – Modern HealthcareAmerica's Greatest Workplaces in Healthcare 2025, 2026 – NewsweekAmerica's Best-In-State Employers (PA) 2025 – ForbesAmerica's Best Employers for Healthcare Professionals 2025 – ForbesAmerica's Best Employers for Women 2025 – ForbesSchedule & CoverageFull-Time, Day ShiftBenefits That MatterMedical, Dental, and Vision coverage starting the first of the month after hirePTO starts Day 1Voluntary 403(b) Retirement Plan with Employer Match through FidelityEmployee Assistance Program providing confidential support for personal and professional well-beingShift Differentials and Premiums for evenings, nights, weekends, and float coverageFriendly, inclusive work family where you'll feel valued and supportedSummary:The Credentialing Quality & Delegation Coordinator ensures system-wide compliance with Joint Commission (TJC), NCQA, CMS, state regulations, and Medical Staff Bylaws governing provider credentialing, privileging, and delegated payer arrangements. This position leads system-level audit and quality initiatives, manages delegated credentialing agreements and rosters, and sustains continuous readiness across all Guthrie entities. The role also serves as Guthrie’s primary liaison to payers, delegated entities, and accrediting bodies, ensuring credentialing integrity, audit readiness, and operational excellence across all facilities. Key PartnershipsMedical Staff Office (MSO) Managers and Credentialing Coordinators (all hospitals)Quality and Patient SafetyCompliance and Corporate RiskRevenue Cycle and Payer RelationsEmployee Health and Human ResourcesDepartment Chairs, Chiefs, and Medical Executive Committees (MECs)Legal, IT, and Analytics TeamsAuthority and Decision RightsHolds system-level authority to pause or return credentialing files, rosters, or privilege forms that do not meet regulatory, bylaw, or delegation standards.Provides final quality sign-off on delegated rosters prior to payer submission.Leads corrective action plans (CAPs) for credentialing, privileging, and delegation findings; escalates unresolved risks to the Director of Medical Staff Services and MEC.Serves as system data steward for CredentialStream and related credentialing databases.Experience:Minimum 3–5 years of progressive experience in medical staff credentialing, healthcare quality, or compliance, preferably within a multi-hospital system.Proficiency in CredentialStream (or equivalent system) and Microsoft Office 365.Strong understanding of TJC, NCQA, CMS, and state credentialing requirements.Familiarity with payer delegation audits and roster management processes.Education:Associate’s degree required; Bachelor’s degree preferred (Healthcare Administration, Business, or related field).Licenses:NAMSS CPCS or CPMSM certification preferred; required within 12 months of hire.Essential Functions:1. Regulatory Compliance & Quality OversightEnsure that all credentialing and privileging processes across Guthrie hospitals and entities comply with TJC, NCQA, CMS, and state/federal regulations, as well as Medical Staff Bylaws.Conduct proactive, periodic, and targeted audits of provider files to ensure accuracy, completeness, and primary source verification integrity.Verify compliance with required credentialing elements, including:Licensure, board certification, DEA, CSR, and malpractice coverageCME (50 CEUs at initial and reappointment per bylaws)Health status documentation at both initial and reappointmentOIG/SAM/state exclusion checks and NPDB queriesMedicare opt-out and sanctions verificationStroke education tracking for applicable providers (NYS Stroke Center compliance)Track, report, and trend compliance findings; develop CAPs and monitor resolution to effectiveness.Maintain survey-ready documentation and evidence binders for all accreditation bodies.2. Delegation & Payer Roster Management (NCQA)Maintain an inventory of all delegation agreements (scope, elements, and audit cadence) for all payers and delegated entities.Lead pre-delegation assessments, annual NCQA delegation audits, and CAP tracking through closure.Maintain and submit accurate delegated rosters system-wide, ensuring payer-specific formatting, timeliness, and reconciliation of acceptance or rejection feedback.Serve as Guthrie’s primary liaison with payers and delegated entities, ensuring readiness for both announced and unannounced audits.Collaborate with Revenue Cycle, Compliance, and Payer Relations to ensure delegation terms remain current and compliant.3. Credentialing Operations & Data IntegrityServe as system Credentialing Software’s data steward, ensuring data uniformity, accuracy, and completeness across all Guthrie facilities.Manage and monitor all expirable credentials and maintain compliance dashboards system wide.Standardize credentialing workflows and documentation practices across all hospitals, ensuring shared templates, audit trails, and compliance with bylaws.Partner with MSO leadership to streamline handoffs for initial appointment, reappointment, FPPE/OPPE, and privilege revisions.4. Governance & Committee SupportSupport system and facility-level Credentials Committees and Medical Executive Committees (MECs) by preparing agenda packets, audit summaries, and compliance reports.Document meeting outcomes, recommendations, and follow-up actions, ensuring timely resolution and regulatory compliance.Provide real-time guidance on credentialing and privileging requirements during committee deliberations.5. Leave of Absence (LOA) & Status ManagementMaintain system-wide tracking for provider leaves of absence, resignations, and reactivations, in collaboration with HR and department leadership.Ensure FPPEs are completed for all providers out of practice greater than six months, with recredentialing prior to reactivation.Update system databases and rosters accordingly to maintain accuracy and compliance.6. Education, Collaboration, and Continuous ReadinessProvide training and education for credentialing and MSO staff on audit standards, delegation requirements, and data integrity practices.Partner with Quality and Compliance to maintain continuous survey readiness and standardized audit tools across all hospitals.Lead system improvement initiatives focused on efficiency, documentation consistency, and data accuracy.Maintain and report Key Performance Indicators (KPIs) to system leadership on a quarterly basis.Performance Metrics (KPIs)Audit Compliance: 95% pass rate on internal quality auditsRoster Timeliness: 100% of delegated rosters submitted on timeExpirable Compliance: 98% current at all timesData Integrity: 99% accuracy in CredentialStreamCAP Closure: 100% corrective actions closed by due dateSurvey Readiness: No repeat or high-severity findings across auditsOther Duties: Other duties as assignedThe pay range for this position is $29.62-$45.02/hr. based on experience.#LI-MD1About the companyJoining the Guthrie team allows you to become a part of a tradition of excellence in health care. In all areas and at all levels of Guthrie, you’ll find staff members who have committed themselves to serving the community.The Guthrie Clinic is an Equal Opportunity Employer.The Guthrie Clinic is a non-profit, integrated, practicing physician-led organization in the Twin Tiers of New York and Pennsylvania. Our multi-specialty group practice of more than 500 physicians and 302 advanced practice providers offers 47 specialties through a regional office network providing primary and specialty care in 22 communities. Guthrie Medical Education Programs include General Surgery, Internal Medicine, Emergency Medicine, Family Medicine, Anesthesiology and Orthopedic Surgery Residency, as well as Cardiovascular, Gastroenterology and Pulmonary Critical Care Fellowship programs. Guthrie is also a clinical campus for the Geisinger Commonwealth School of Medicine.