Coordinator, Credentialing Quality & Delegation - Legal - Full Time

Guthrie Enterprise • Sayre, NY

4d

About The Position

The Credentialing Quality & Delegation Coordinator ensures system-wide compliance with Joint Commission (TJC), NCQA, CMS, state and federal regulations, and Medical Staff Bylaws governing provider credentialing, privileging, and delegated payer arrangements. The coordinator leads system-level audit and quality initiatives, manages delegated credentialing agreements and rosters, and maintains continuous readiness across Guthrie entities. The role serves as Guthrie’s primary liaison to payers, delegated entities, and accrediting bodies, supporting credentialing integrity, audit readiness, and operational excellence across facilities.

The position has system-level authority to pause or return credentialing files, rosters, or privilege forms that do not meet applicable standards, and provides final quality sign-off on delegated rosters before payer submission. It leads corrective action plans and escalates unresolved risks to the Director of Medical Staff Services and Medical Executive Committee. The coordinator also serves as data steward for CredentialStream and related credentialing databases.

This is a full-time, day-shift position. The listed pay range is $29.62–$45.02 per hour, based on experience. The role partners with Medical Staff Office staff, Quality and Patient Safety, Compliance and Corporate Risk, Revenue Cycle and Payer Relations, Employee Health and Human Resources, department chairs, chiefs and Medical Executive Committees, as well as Legal, IT, and Analytics teams.

Requirements

• At least 3–5 years of progressive experience in medical staff credentialing, healthcare quality, or compliance; the posting states experience in a multi-hospital system is preferred.
• Proficiency in CredentialStream or an equivalent system.
• Proficiency in Microsoft Office 365.
• Strong understanding of TJC, NCQA, CMS, and state credentialing requirements.
• Familiarity with payer delegation audits and roster management processes.
• Associate’s degree required.
• NAMSS CPCS or CPMSM certification required within 12 months of hire.

Nice To Haves

• Experience in a multi-hospital system.
• Bachelor’s degree in Healthcare Administration, Business, or a related field.
• NAMSS CPCS or CPMSM certification preferred.

Responsibilities

• Ensure credentialing and privileging processes across Guthrie hospitals and entities comply with TJC, NCQA, CMS, state and federal regulations, and Medical Staff Bylaws.
• Conduct proactive, periodic, and targeted provider-file audits, including checks of required credentialing elements and primary-source verification integrity.
• Track, report, and trend compliance findings; develop corrective action plans and monitor them through effective resolution.
• Maintain survey-ready documentation and evidence binders for accrediting bodies.
• Maintain an inventory of delegation agreements, including their scope, elements, and audit cadence.
• Lead pre-delegation assessments and annual NCQA delegation audits, and track corrective actions through closure.
• Maintain and submit accurate system-wide delegated rosters, meeting payer-specific formatting and timing requirements and reconciling acceptance or rejection feedback.
• Serve as Guthrie’s primary liaison with payers and delegated entities, supporting readiness for announced and unannounced audits.
• Collaborate with Revenue Cycle, Compliance, and Payer Relations to keep delegation terms current and compliant.
• Serve as credentialing software data steward, ensuring data uniformity, accuracy, and completeness across Guthrie facilities.
• Manage and monitor expirable credentials and maintain system-wide compliance dashboards.
• Standardize credentialing workflows and documentation practices across hospitals, including shared templates and audit trails.
• Partner with Medical Staff Office leadership to streamline processes for initial appointment, reappointment, FPPE/OPPE, and privilege revisions.
• Support Credentials Committees and Medical Executive Committees by preparing agenda packets, audit summaries, and compliance reports.
• Document committee outcomes, recommendations, and follow-up actions, and provide real-time guidance on credentialing and privileging requirements during deliberations.
• Track provider leaves of absence, resignations, and reactivations in collaboration with HR and department leadership.
• Ensure FPPEs are completed for providers out of practice for more than six months and that recredentialing occurs before reactivation.
• Update system databases and rosters to maintain accuracy and compliance.
• Train and educate credentialing and Medical Staff Office staff on audit standards, delegation requirements, and data-integrity practices.
• Partner with Quality and Compliance to maintain continuous survey readiness and standardized audit tools across hospitals.
• Lead system improvement initiatives focused on efficiency, documentation consistency, and data accuracy.
• Maintain and report KPIs to system leadership quarterly.
• Perform other duties as assigned.

Benefits

• Medical, dental, and vision coverage starting the first of the month after hire.
• Paid time off starting on day one.
• Voluntary 403(b) retirement plan with employer match through Fidelity.
• Employee Assistance Program offering confidential personal and professional well-being support.
• Shift differentials and premiums for evenings, nights, weekends, and float coverage.
• Friendly, inclusive work environment.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree