Credentialing Coordinator

POSITION SUMMARY:

The full-time Medical Department Credentialing Coordinator serves and advocates for clinicians and provides administrative support to the Medical and Quality Assurance Departments. He/she serves as Credentialing Manager for Esperanza, coordinates provider on and off-boarding and manages the department budget. ESSENTIAL FUNCTIONS Credentialing Guide clinicians (and other licensed professional staff including BHC, Dentists, Nurses, and Dieticians) through the credentialing, privileging, and re-credentialing processes. Internal Credentialing

Request, gather, and maintain on file all relevant documentation for internal and external provider/staff credentialing Create, maintain, and update credentialing reports and spreadsheets.

Governmental Licensing

Coach clinicians in how and when to apply for licenses. Submit initial supervision agreements (PA’s) and prescriptive authority applications (CRNP’s) for midlevel practitioners with state medical and nursing boards. Take lead in keeping up to date with changing requirements. Maintain on file collaborative agreements for CRNP’s. Prepare and submit credentialing applications for new clinicians with Medicaid and Medicare.

Insurance/External Privileging

Prepare and submit privileging applications for new clinicians with insurance companies. Request and maintain hospital privileges for applicable clinicians. Maintain a filing system that allows for timely retrieval of requested information. Keep a constant flow of communication between the insurance companies, hospitals, malpractice companies and medical billing agencies, to ensure EHC is in compliance with all state, city and federal regulations. Research and resolve any and all credentialing issues. Update and inform Medical Director, Dental Director, Behavioral Health Director, HR Director, Executive Director, and Billing Manager of any issues, changes in policies and/or provider status changes that may arise unexpectedly. Keep a professional and friendly relationship with all network representatives.

Re-credentialing

Manage the internal re-privileging process for clinicians and other licensed professional staff every two years (concurrent with the renewal date of providers’ licenses). Create and maintain Council for Affordable Quality Healthcare (CAQH) profiles for billable practitioners in coordination with the Dental and BHC departments.

Support clinician completion of continuing medical education requirements and reimbursements within Esperanza guidelines. Medical Director and Clinician Leadership Support Support projects of Medical Director, Site Medical Directors and Associate Medical Directors as needed and as available. Know and communicate Medical Department policy to clinicians and staff when appropriate. Assist with drafting, editing, compiling, and formatting medical department policy and procedure. Clinician Support Provide spiritual support, encouragement to clinician staff as needed Take initiative to check in with clinicians (especially at K&A), advocate for clinician wellbeing and concerns, and work toward resolution of any problems that arise. Respond to clinician communication in a timely fashion. Coordinate ACLS and BLS training for medical clinicians every 2 years. Human Resources Participate in clinician screening and interviewing. Occasionally assist with clinician recruiting at conferences, career fairs, and other events. Communicate in a timely fashion with HR about clinician start dates, FMLA’s, leaves, and FTE changes. Coordinate and plan staff retreats with HR, as needed. Coordinate onboarding for oncoming clinicians, communicating with HR, IT and appropriate departments Coordinate exit process for departing clinicians including sending farewell letters to patients, scheduling a goodbye dinner, communicating with HR and appropriate departments, and overseeing patient reassignment in collaboration with Medical Department Administrator. Additional Responsibilities Help to cover tasks during absences of Medical Department Administrator. Coordinate tracking and maintenance of Athena Billable license count, working with IT and Finance to ensure that appropriate number of licenses are maintained Coordinate access to external EMR systems Budget Management Manage departmental budget, track expenses, and ensure timely reimbursements. Prepare monthly credit card usage report. Project department expenses for annual budget proposal. COMPETENCIES Demonstrates Godly character and lifestyle in keeping with authority of the Bible Self-directed and motivated. Exceptional organizational and interpersonal skills, with attention to detail required. Independent thinker and good problem-solver. Strong oral/written communication is required. Establishes and maintains open lines of communications with other staff. Ability to work collaboratively in a team and manage multiple priorities, utilize effective time management skills, and exercise sound administrative judgment. Ability to analyze systems and to develop creative solutions to problems. Demonstrated ability to work well with people of various ages, backgrounds, ethnicities, and life experiences. Mature, well-spoken. Maintains discretion and confidentiality in communicating with others. Wisdom and courage to evaluate candidates in a way that preserves Esperanza’s mission and honors and respects those who may not be good fits. Communicates the love of Christ through interactions, not complaining or arguing, but expressing hope in Christ and His promises. Seeks to serve Christ and proclaim the gospel in word and deed. KNOWLEDGE, SKILLS, AND QUALIFICATIONS Bachelor’s degree preferred. NAMSS certification preferred. At least 1-2 years of administrative experience preferred. Bilingual English/Spanish preferred. Experienced with MS Word and Excel. WORKING CONDITIONS Must be able to work in regular office environment.