Credentialing Coordinator

Job Description

General Description :

Under general direction, initiates verification of initial and reappointment applications and coordinates and maintains medical staff databases for credentialing and verification needs.

Essential Responsibilities :

Oversees and initiates the entire credentialing and verification processes of OU Health staff for initial and reappointment applications to include standardized, cost-effective verification that comply with Joint Commission on Accreditation of Healthcare Organizations (TJC), National Committee for Quality Assurance (NCQA), Centers for Medicaid and Medicare (CMS), federal and state law. Analyzes verification information, to include identifying red flag and / or adverse information and notifying Medical Staff leadership in accordance with policies & procedures. Monitoring of expiring information such as but not limited to DEA, license, professional liability insurance, and specialty board certification status; maintain and update credentials file(s). Compliant with department defined turn-around-times and key performance indicators Timely, accurate, and complete database entries and maintenance of electronic files as required Assists with the development and implementation of credentialing and recredentialing workflows to ensure efficient and effective alignment of processes including maintenance of delineation of privileges. Maintains a working knowledge of relevant regulatory standards (i.e., TJC and NCQA), state and federal requirements, and applicable Medical Staff Bylaws, rules and regulations. Assists with practitioner onboarding and orientation Supports medical staff meetings Participation in projects

General Responsibilities :

• Performs other duties as assigned.

Minimum Qualifications :

Education : Associate’s degree or higher

Experience : At least two (2) years of experience in a medical staff office, healthcare, legal, human resources or finance setting.

Licensure / Certifications / Registrations Required : Currently a Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) or willingness to achieve certification within 12 months of becoming eligible.

Knowledge, Skills and Abilities :