Credentialing Coordinator III

MAJOR RESPONSIBILITIES

· Leads, coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility.

· Conducts thorough investigation, research, and primary source verification of all components of the application file.

· Identifies issues that require additional investigation and evaluation, validates discrepancies, and ensures appropriate follow-up.

· Prepares credentials file for completion and presentation to Credentials Committees, ensuring file completion within required time periods.

· Processes requests for privileges, ensuring compliance with criteria outlined in clinical privilege delineation.

· Responds to inquiries from other healthcare organizations, interfaces with internal/ external customers on day-to-day credentialing/privileging issues as they arise.

· Assists with audits performed by accrediting or regulatory bodies.

· Perform internal file audits.

· Utilizes and maintains the credentialing database, optimizing efficiency, and performs queries, reports, and document generation.

· Monitors the initial, reappointment, and expirable process for practitioners, ensuring compliance with regulatory bodies (Joint Commission, NCQA, URAC, CMS, Federal/State), bylaws, policies/procedures, and delegated agreements

· OPPE/FPPE data collection/review as assigned

· Maintains strict confidentiality of all data and information.

· Performs miscellaneous job-related duties as assigned.