Credentialing Coordinator

Overview The Hospital Credentialing Coordinator reports to the Credentialing Manager for Patient Financial Services. Under general supervision and within Brown University Health policies and procedures, the coordinator performs credentialing and/or re‑credentialing of hospital‑employed physicians and other ancillary providers for Brown University Health facilities. Employees are expected to role‑model the organization’s values of Compassion, Accountability, Respect, and Excellence and to demonstrate the core success factors of trusting and valuing differences, patient and community focus, and collaboration. Responsibilities Initiates the application process by distributing the credentialing application packet and hospital criteria to applying physicians. Completes collection and processes applications for initial appointments, reappointments, and additional privileges for all credentialed practitioners. Obtains primary source verification from sources such as medical schools, residency programs, previous hospitals, licensing boards, and other required sources. Maintains the credentialing database and monitors licenses, malpractice insurance, DEA certificates, board certifications, sanctions, and disciplinary actions. Maintains active and archived credentialing files and performs delegated credentialing for health plans. Provides assistance in the credentialing verification portion of accreditation and regulatory surveys, and assists in developing policies and procedures. Builds and maintains working relationships with physicians, support staff, billing staff, insurers, and department administrative personnel to expedite information exchange and resolve common issues. Receives and answers all questions related to third‑party credentialing within scope of responsibility. Adheres to production goals and directives and assists in auditing delegated credentialing functions. Audits files for complete information upon submission, requests missing data from providers, and coordinates with client health plans to keep credentialing and enrollment lag time at minimum levels. Acts as primary liaison with client health plans for database issues, participates in special projects evaluating health‑plan operational requirements and reimbursement, and researches payment‑denial issues related to provider participation status, specialty, and service locations. Manages National Provider Identifier (NPI) number generation, tracking, and revisions; creates or updates CAQH profiles to maintain continuous participation with third‑party payers. Reminds staff of license renewal deadlines, documents tracking and dissemination, and forwards renewed credentials to affiliations. Monitors status and reports immediately to the manager those who do not meet Joint Commission standards. Assists in accurate and timely completion of Electronic Data Interchange (EDI) enrollments with various payors and clearinghouses, including follow‑up status. Creates a common understanding of initial credentialing and re‑credentialing processes for stakeholders to grasp their importance and expectations from health plans and hospitals. Maintains strong knowledge of managed‑care systems, contract‑related activities, legal, regulatory, and operational requirements, and stays current with NCQA, CMS, and other regulatory standards. Stays abreast of latest credentialing developments, trends, and techniques. Performs other duties as assigned. Minimum Qualifications Associate’s degree in health services or a related field (preferred) or an equivalent combination of education and experience. Minimum of three years of relevant experience working in a hospital, physician office, or multi‑entity credentialing environment. Demonstrated interpersonal skills necessary to communicate and gather information from all levels of personnel and to handle highly confidential data securely and trustworthily. Knowledge of credentialing principles for hospitals, provider networks, and payers. Intermediate computer skills, credentialing software experience, and information‑systems knowledge with the ability to generate management and production reports, documents, and correspondence independently. Current knowledge of Joint Commission requirements, state regulations, and credentialing processes. Current knowledge of NCQA and Medicare credentialing standards and other regulatory requirements. Continuing education in federal and regulatory education related to credentialing as required. Normal working environment with little to no exposure to adverse conditions. Additional Information Pay Range: $20.96–$34.61 per hour. Location: Remote – Massachusetts (N/A) Boston, Massachusetts 02108. Work Type: 730‑400 pm. Work Shift: Day. Daily Hours: 8 hours. Driving Required: No. EEO Statement Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment. #J-18808-Ljbffr LCS Lifespan Corporate Services d/b/a Brown University Health