Coordinator - Credentialing & Privileging

Legacy Community Health•Houston, TX

1d•Hybrid

About The Position

Join us as we pioneer a new era in healthcare credentialing at Legacy Community Health. As the Credentialing & Privileging Coordinator, you'll be at the forefront of digital transformation, leveraging cutting-edge technology to streamline the onboarding and credentialing process for our healthcare providers. Be a vital player in the dynamic healthcare ecosystem, ensuring seamless compliance with Medicare and other regulatory standards. Collaborate with external organizations to revolutionize provider onboarding and payor enrollment functions. Empower healthcare professionals by maintaining accurate, data-driven credentialing and privileging information. Drive innovation and continuous improvement in credentialing processes to enhance operational efficiency. Contribute to community health impact by ensuring our providers meet the highest standards of care.

Requirements

Associate's Degree or equivalent experience; Bachelor's Degree preferred for those aspiring to lead transformative credentialing initiatives.
Minimum of five years' experience as a credentialing coordinator or specialist, with a focus on innovation and digital transformation.
Proven expertise in credentialing and privileging guidelines, leveraging technology for enhanced accuracy and compliance.
Detail-oriented with exceptional organizational skills to manage digital and physical processes seamlessly.
Ability to thrive under pressure in a fast-paced, tech-driven environment.
Strong collaborative mindset with a commitment to confidentiality and professional integrity.
Advanced proficiency in MS Office, particularly Excel, and adept at mastering credentialing systems.
Professional communication skills for engaging with executive-level stakeholders and driving change.

Nice To Haves

FQHC credentialing experience and payor enrollment expertise are highly valued.

Responsibilities

Innovatively obtain and verify credentialing information from multiple primary sources, aligning with cutting-edge federal and state standards.
Ensure regulatory compliance through agile application management and primary source verification.
Lead the onboarding process for providers, integrating advanced document requests and verification methods.
Serve as the tech-savvy contact for provider onboarding and privileging, optimizing review activities with digital tools.
Maintain credentialing files and data systems, enhancing compliance with group delegation and audit requirements.
Orchestrate credentialing audits, ensuring alignment with managed care delegated credentialing contracts.
Leverage digital platforms for maintaining up-to-date privileging data, optimizing the expirable process management.
Utilize CAQH and other technologies to ensure accurate provider records and proactive notification of expiring credentials.
Deliver data-driven reports to the SVP of Compliance and facilitate impactful board presentations on privileging.
Drive continuous improvement in credentialing standards through strategic file reviews and policy development.