Credentialing Coordinator

Job Description

Job Description

VISION, MISSION & VALUES:

Every employee of SIHF Healthcare is expected to uphold our vision, mission, and values. Our actions will reflect our values of Compassion, Diversity/Inclusivity, Excellence, Integrity, Respect and Stewardship creating a culture in which all individuals are treated with dignity and respect. This will result in our vision of an “Enriched health and life in a just society” through the fulfillment of our mission to build partnerships, develop safe and affordable housing, community engagement in building trust and solutions, foster economic development, provide access to comprehensive health care services, and reduce disparities.

CUSTOMER SERVICE COMPLIANCE STATEMENT:

Treat every person with dignity, respect and kindness by listening with your full attention, addressing questions/concerns immediately, and accepting responsibility to follow through by always doing what you say you will do. You support our customers, and your team, by being patient, understanding and positive, knowing that you are SIHF Healthcare to those we serve.

POSITION DESCRIPTION:

Works under direction of the Sr. Director of Health Center Compliance and Provider Support Services Manager to assist with all functions of provider and staff credentialing and re-credentialing activities with adherence to State and Federal Regulations; Accrediting Agency Requirements; Delegated Credentialing Requirements; Organizational Bylaws, Rules and Regulations and Credentialing & Privileging Policy with consistent exercise of discretion and judgment.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

1. Assist with all functions of credentialing and privileging processes with adherence to State and Federal Regulations; Accrediting Agency Requirements; Delegated Credentialing Requirements; Organizational Bylaws, Rules and Regulations and Credentialing & Privileging Policy.

1. Assist with initial credentialing and re-credentialing process of employed and contracted healthcare providers to provide services for SIHF Healthcare.

1. Assist with the initial credentialing and re-credentialing process of employed and/or contracted clinical support staff to provide services for SIHF Healthcare.

1. Coordinate daily with SIHF Healthcare Human Resources to ensure clinical support staff are onboarded efficiently and in a timely manner.

1. Assist with preparation and maintenance of Collaboration Agreements with midlevel providers and their supervising physician.

1. Assist with maintenance of confidential Credentialing Files, in accordance with applicable regulations, to ensure complete and accurate information, including current licensure, Federal DEA, and Board Certifications (if applicable).

1. Assist with application reviews with Department Chairs, Credentials Committee and Chief Medical Officer for review and recommendation.

1. Assist with preparation of meeting packets, agenda and minutes of the Credentialing Committee meetings and preparation of provider letters of acceptance or non-acceptance and Chief Medical Officer’s Report on applications to the Governing Board.

1. Assist with the implementation and coordination of MD Staff Credentialing Software at SIHF Healthcare.

1. Assist with initial enrollment and re-enrollment of FQHC Health Centers into Medicaid, Medicaid Managed Care Organizations, Medicare, Medicare Advantage Plans, Private Insurances, and any other payers contracted by SIHF Healthcare.

ADDITIONAL POSITION DESCRIPTION:

1. Assist with initial enrollment and re-enrollment of healthcare providers into Medicaid, Medicaid Managed Care Organizations, Medicare, Medicare Advantage Plans, Private Insurances, and any other payers contracted by SIHF Healthcare.

1. Assist with monthly delegated credentialing reports to Health Plans and facilitate communication to non-delegated Health Plans to ensure that provider information is correct and current.

1. Ensure that the information regarding provider’s enrollment into the available health plans is current and up to date and communicated with Medical Staff, Health Centers, and Staff.

1. Work with supervision with respect to specific objectives; in most tasks and projects assigned, following pre-determined methods, work sequence, scheduling, and how to achieve objectives of assignments; operate within specific policy guidelines.

1. Perform other duties as assigned.

KNOWLEDGE, SKILLS, ABILITIES:

1. Ability to read and interpret documents such as regulatory and accrediting agency requirements, safety rules, operating and maintenance instructions.

1. Ability to assist with writing routine reports and correspondence.

1. Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.

1. Ability to work in a fast-paced environment.

1. Intermediate personal computer skills, including electronic mail, routine database activity, work processing, spreadsheet, graphics, etc.

1. Ability to handle multiple tasks simultaneously.

1. Ability to work independently.

1. Must possess effective written and verbal communication skills.

1. Must be knowledgeable of computers and Microsoft Windows Programs (Word and Excel).

1. Exhibit a polished and professional appearance.

EDUCATION AND EXPERIENCE:

Associate degree from college or university or at least two (2) years related experience and/or training or equivalent combination of education and experience.

COMPLIANCE STATEMENT:

Abide by the requirements of all applicable State and Federal laws.

MEDICAL HOME STATEMENT:

Be aware and understand the expectations and responsibilities of the Patient Centered Medical Home. Understand role, complete relevant duties, and the requirement to maintain highest level of proficiency within scope, as part of this team-based approach in the patient care continuum.

PHYSICAL DEMANDS:

Light physical activity performing non-strenuous daily activities of an administrative nature.

WORK SCHEDULE:

Normal work hours for this position are Monday through Friday dayshift. Occasional attendance at off-site meetings required with no overnight stay.