Lead Credentialing Coord

Position Summary

This person will work closely with the Manager, Medical Staff Services and also be back up to the Manager. The Lead Credentialing Coordinator will be responsible for assigning, maintaining and leading credentialing coordinators staff on the processes for credentials and process of applications through completeness. Provides training to the credentialing coordinator's in all aspects of daily responsibilities in the Medical Staff Office and other assist with training of other professional staff involved with the application process. Provide resource to credentialing coordinators on credentialing and privileging questions. Assist with assignment of applicants to credentialing coordinators. Examine and evaluate credentials information and results obtained by cross-referencing and comparing to information reported on application and curriculum vitae. Investigate discrepancies and misstatements with applicant and other primary sources as necessary through to final resolution. Identify key issues in core credentials data. Report identified adverse information and unresolved questions to Manager, Medical Staff services. Maintain accurate and current credentials database for all assigned applicants. Monitor and track application status, credentials process and provider enrollment process. Perform all essential functions in compliance with all accreditation standards (JCAHO, NCQA), federal and state laws and regulations (CMS, DOH) and medical staff bylaws and policies/procedures. Maintain knowledge base as applicable to credentialing and provider enrollment. Recognize and maturely handle a variety of situations, often of a confidential or urgent nature.

Primary Position Responsibilities

1. Application Processing - Performs quality review of all applications for completeness and all required documentation. Examine information reported for missing data elements, timelines, and time gaps. Complete CAQH, PECOS, Medicaid, and NPPES processes. Coordinate events, e.g. Doctors day
2. Unassigned Call Schedule- Coordinate, monitor and oversee the unassigned On-Call Schedule as needed
3. Provide mentoring and training of Credentialing Coordinators
4. Data Entry - Utilize and update credentialing system and electronic files
5. Ongoing Monitoring of Sanctions, e.g. OIG, SAM, Medicare Opt Out, State licensed sanctions
6. Customer Service
7. Administrative Support - Assist with Medical Staff Dues Bank Account and Initial Application fees. Respond to requests for Hospital affiliations. Respond to requests for file documents (see policy and procedure)

Qualifications

Minimum Education:

Required:

High School Graduate or Equivalent

Preferred:

Certificate and/or advanced Specialized or Technical Training in Medical Staff Services or Associate's Degree

Minimum Years of Experience (Amount, Type and Variation):

Required:

Two (2) years of credentialing or provider enrollment experience with progressive responsibility

Preferred:

Five (5) years of credentialing or provider enrollment experience with progressive responsibility

License, Registry or Certification:

Required:

None

Preferred:

Certification by NAMSS as a Certified Provider Credentials Specialist (CPCS) or the ability to become certified within the time periods established by NAMSS from date of hire

Knowledge, Skills and/or Abilities:

Required:

Ability to prioritize, work in a fast-paced environment; meet ongoing schedules and deadlines, detailed oriented, organized, good judgment, self motivated, ability to multi task and work independently. Ability to research and analyze various types of information and make appropriate recommendations, excellent communication (verbal and written), interpersonal and time management skills. Familiarity with the Joint Commission standards, Proficient in the use of multiple computer software programs. Demonstrated ability to provide training to new staff and ongoing training.

Preferred:

Experience with MSOW Software

Hunterdon Health is committed to providing a competitive benefit package to our employees. Benefit offerings vary based on status and may include but not be limited to medical, dental, vision, family forming, paid time off, tuition reimbursement, and retirement savings.

The hiring range listed is the potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement. When determining an applicant's hourly rate and/or base salary, several factors may be considered as applicable (e.g., years of relevant experience, education, internal equity, and specialty).