CREDENTIALING COORDINATOR

• Credentialing Coordinator, Medical Staff Office, Harvard, Days, 80 hrs / 2 wks
• Location: Harvard Hospital

Performs duties related to the Medical Staff Office functions, which include but are not limited to credentialing new and established healthcare providers, maintaining information which includes primary source verification, follow-up, data collection, data entry, and document review. Participates in all facets of medical staff meetings, which includes scheduling, distributing notices, recording minutes, as appropriate. Participates in quality studies. Performs other duties, as assigned.

• Maintains high quality, timely and accurate credentialing processes of medical and allied healthcare professionals based upon system policies and procedures.
• Assists in the credentialing process by entering, logging, scanning information into the system for initial appointments, reappointments, add-on applications and maintenance.
• Completes and ensures compliance and delivery of required information to all customers in a timely manner.
• Processes and maintains credentialing and recredentialing in accordance with Mercy policies and procedures, Joint Commission standards, State and Federal regulatory guidelines.
• Ensures that all credentials are current and complete pursuant to expiration date of medical licensure, board certification, professional liability insurance coverage, DEA and other pertinent information per Mercy policy/procedure.
• Monitors collection of all information received. Follow-up on missing items/documentation/incomplete forms. Submits follow-up requests, as needed.
• Identifies and evaluates potential red flags and works in collaboration with practitioner(s) to document the issue and practitioner response.
• Advises supervisor and/or director of questionable information received and any issues identified during processes.
• Submits closed files for audit/final review and secures missing items as identified by audit/final review.
• Maintains all credentials files to ensure that all correspondence is accurately filed; is knowledgeable and current in regard to process and legal/regulatory requirements.
• Maintains compliance with Mercy policies/procedures, federal, state and all accrediting agencies as required.
• Responds to verification requests from hospitals and managed care organizations. Orders Medical Staff Office supplies. Bills for Medical Staff dues. Works with agencies and practitioners to assemble credentials files and arranges for review and secures signatures for locum tenens privileges. Serves as a resource for the Medical Staff on Medical Staff Bylaws issues. Assists physicians in developing criteria for privileging. Schedules and secures rooms for Medical Staff meetings, sends out notices, drafts agenda, assembles meeting materials, drafts minutes and follow-up correspondence. Maintains information in CACTUS database. Produces labels and writes reports from database. Maintains meeting attendance records in CACTUS database. Maintains Mercy sponsored CME records in CACTUS database.

Associate's degree and 1 year of healthcare credentialing experience preferred(healthcare facility, managed care setting, CVO, or medical staff office), or a minimum of 5 years of experience in credentialing (preferred) or or a minimum of 5 years of experience healthcare business area required.
CPMSM or CPCS preferred or commitment to pursue certification within two years.

The Special Physical Demands are considered Essential Job Functions of the position with or without reasonable accommodations.
In order to perform the demands of this job, the employee may sit for long periods, exerting up to 10 pounds of force occasionally, walking and standing occasionally. The employee is required to frequently reach with hands and arms, finger, handle, talk and hear. Manual dexterity is required.