Credentialing Coordinator III

Sutter Health•Sacramento, CA

2d•Remote

About The Position

Responsible for completion of credentialing functions. Ensures program integrity and compliance with standards, federal/state requirements, and health plan credentialing requirements. Maintains relationships with health plan auditors, communicates and works with physician leaders on credentialing issues, works with other departments in multiple areas that relate to credentialing issues. Audits Credentialing Verification Organization's released files to ensure it obtains primary source verification of required physician information. Maintains database of current and accurate information concerning licensure, board certification, professional liability coverage and claims for physicians, contracted providers and Allied Health Professionals.

Requirements

HS Diploma or General Education Diploma (GED)
2 years recent relevant experience
Knowledge of medical provider credentialing and accreditation principles, processes, procedures, and documentation.
Knowledge of computer spreadsheets and other related applications.
Ability to use independent judgment and to manage and impart confidential information.
PC skills (MS Word, MS Excel, and MS Access) and proficiency regarding data entry skills.
Organizational skills with ability to prioritize, problem solve and meet deadlines.
Ability to analyze, interpret, and draw inferences from research findings, and prepare reports.
Able to use independent judgment and to manage and impart confidential information.
Ability to analyze data/reports and to make recommendations

Responsibilities

Completion of credentialing functions.
Ensuring program integrity and compliance with standards, federal/state requirements, and health plan credentialing requirements.
Maintaining relationships with health plan auditors.
Communicating and working with physician leaders on credentialing issues.
Working with other departments in multiple areas that relate to credentialing issues.
Auditing Credentialing Verification Organization's released files to ensure it obtains primary source verification of required physician information.
Maintaining database of current and accurate information concerning licensure, board certification, professional liability coverage and claims for physicians, contracted providers and Allied Health Professionals.