Credentialing and Privileging Coordinator

HealthPoint•College Station, TX

About The Position

The Credentialing and Privileging Coordinator is responsible for coordinating all activities related to the credentialing and re-credentialing of HealthPoint clinical staff, a Federally Qualified Health Center (FQHC), ensuring their privileges align with their qualifications. Clinical Staff includes licensed practitioners (for example, Physician, Dentist, Physician Assistant, Nurse Practitioner), other licensed or certified practitioners (for example, Registered Nurse, Licensed Practical Nurse, Registered Dietician, Certified Medical Assistant), and other clinical staff providing services on behalf of HealthPoint (for example, Medical Assistants or Community Health Workers that do not require licensure or certification).

Requirements

Education: High School diploma
Valid Texas Driver’s License.
Possesses advanced work-related skills beyond completion of high school, including written and verbal communications skills, computational and computer skills, mathematical, technical or health care related knowledge frequently acquired through completion of a licensed skilled trade, para-profession or practical business knowledge.
Possesses an understanding of the trade/profession at a level that allows the employee to select methods for others to use (from those already in existence in the profession). (Level 4)
Maintains current knowledge of standards of care and practices, typically acquired through
Prepares more complex documents in Microsoft Word, including creating tables, charts, graphs and other elements.
Uses Microsoft Excel to create tables and simple displays of information
Creates basic presentations in Microsoft PowerPoint.
Possesses advanced general skills, including written and verbal communications skills, computational and computer skills, and mathematical knowledge frequently acquired through completion of a general bachelor's degree program or associate’s degree with acquired business experience.

Nice To Haves

Knowledge of healthcare regulations such as HIPAA, Stark Law, and Anti-Kickback Statute.

Responsibilities

Credentialing and Privileging Oversight
Responsible for the coordination of the credentialing and recredentialing process for all HealthPoint clinical staff joining HealthPoint, ensuring compliance with federal and state regulations.
Coordinate with various departments to gather and verify necessary documents, including but not limited to licenses, certifications, education, training, and relevant work history.
Conduct primary and secondary source verification of credentials to ensure accuracy and validity.
Ensure verification of HealthPoint’s clinical staff of the following, as applicable:
Current licensure, registration, or certification from a primary source
Education and training for initial credentialing using:
Primary sources for Licensed Independent Practitioners (LIPs)
Primary or other sources (as determined by HealthPoint) for other licensed or certified practitioners (OLCPs) and any other clinical staff;
Completion of a query through the National Practitioner Data Bank (NPDB), an electronic information repository containing information on medical malpractice payments and certain adverse actions related to health care practitioners, entities, providers, and suppliers;
Clinical staff members identity for initial credentialing using a government-issued picture identification;
Drug Enforcement Administration (DEA) registration; and
Current documentation of basic life support training.
Ensures initial and recurring review, every two years, of all clinical staff.
Ensures the following for privileging clinical staff, as applicable:
Verification of fitness for duty, immunization, and communicable diseases status;
For initial privileging, verification of current clinical competencies via training, education, and as available, reference reviews;
For renewal of privileges, verification of current clinical competence via peer review or other comparable methods (for example, supervisory performance reviews; and
Maintain records of all clinical staff’s denial, modification, or removal of privileges based on assessments of clinical competence and/or fitness for duties
Maintain updated credentialing and privileging files and databases, ensuring completeness and accuracy of information.
HealthPoint Contract Providers Documentation, whether through formal, written referral agreements, with other provider organizations that provide services within scope of HealthPoint’s project, ensure that such providers are:
Licensed, certified, or registered as verified through a credentialing process, in accordance with applicable federal, state, and local laws; and
Competent and fit to perform the contracted or referred services, as assessed through a privileging process.
Respond to Inquiries and Reports
Collaborate and communicate with internal stakeholders, including medical staff, human resources, compliance, and legal departments, to ensure alignment with compliance with the credentialing requirements.
Communicate credentialing decisions and updates to providers in a timely and professional manner.
Quality Assurance and Compliance
Participate in internal and external audits related to credentialing and privileging.
Training and Education
Provide training and education to providers and staff on credentialing requirements, processes, and best practices.
Offer guidance and support to provide throughout the credentialing process, addressing any questions or concerns.
Professional Development
Stay abreast of changes in healthcare regulations, accreditation standards, and industry trends related to credentialing and privileging.
Participate in professional development activities, such as conferences and workshops, to enhance knowledge and skills in credentialing practices.
Performs other duties as assigned.
Effectively carries out tasks and responsibilities beyond core job duties and primary role. The additional duties may vary from time to time and encompass a wide range of activities that contribute to the overall success of the organization (floating, schedule variations, assisting co-workers, patients, visitors, customers, leaders, and other stakeholders in support of the organization.)