Credentialing Coordinator

So IL Health Care Foundation•Sauget, IL

2d•$18 - $27•Onsite

About The Position

Works under the direction of the Sr. Director of Health Center Compliance and Provider Support Services Manager to assist with all functions of provider and staff credentialing and re-credentialing activities. This role requires adherence to State and Federal Regulations, Accrediting Agency Requirements, Delegated Credentialing Requirements, Organizational Bylaws, Rules and Regulations, and the Credentialing & Privileging Policy, with consistent exercise of discretion and judgment.

Requirements

Ability to read and interpret documents such as regulatory and accrediting agency requirements, safety rules, operating and maintenance instructions.
Ability to assist with writing routine reports and correspondence.
Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.
Ability to work in a fast-paced environment.
Intermediate personal computer skills, including electronic mail, routine database activity, work processing, spreadsheet, graphics, etc.
Ability to handle multiple tasks simultaneously.
Ability to work independently.
Must possess effective written and verbal communication skills.
Must be knowledgeable of computers and Microsoft Windows Programs (Word and Excel).
Exhibit a polished and professional appearance.
Associate degree from college or university or at least two (2) years related experience and/or training or equivalent combination of education and experience.
Abide by the requirements of all applicable State and Federal laws.
Be aware and understand the expectations and responsibilities of the Patient Centered Medical Home. Understand role, complete relevant duties, and the requirement to maintain highest level of proficiency within scope, as part of this team-based approach in the patient care continuum.

Responsibilities

Assist with all functions of credentialing and privileging processes with adherence to State and Federal Regulations; Accrediting Agency Requirements; Delegated Credentialing Requirements; Organizational Bylaws, Rules and Regulations and Credentialing & Privileging Policy.
Assist with initial credentialing and re-credentialing process of employed and contracted healthcare providers to provide services for SIHF Healthcare.
Assist with the initial credentialing and re-credentialing process of employed and/or contracted clinical support staff to provide services for SIHF Healthcare.
Coordinate daily with SIHF Healthcare Human Resources to ensure clinical support staff are onboarded efficiently and in a timely manner.
Assist with preparation and maintenance of Collaboration Agreements with midlevel providers and their supervising physician.
Assist with maintenance of confidential Credentialing Files, in accordance with applicable regulations, to ensure complete and accurate information, including current licensure, Federal DEA, and Board Certifications (if applicable).
Assist with application reviews with Department Chairs, Credentials Committee and Chief Medical Officer for review and recommendation.
Assist with preparation of meeting packets, agenda and minutes of the Credentialing Committee meetings and preparation of provider letters of acceptance or non-acceptance and Chief Medical Officer’s Report on applications to the Governing Board.
Assist with the implementation and coordination of MD Staff Credentialing Software at SIHF Healthcare.
Assist with initial enrollment and re-enrollment of FQHC Health Centers into Medicaid, Medicaid Managed Care Organizations, Medicare, Medicare Advantage Plans, Private Insurances, and any other payers contracted by SIHF Healthcare.
Assist with initial enrollment and re-enrollment of healthcare providers into Medicaid, Medicaid Managed Care Organizations, Medicare, Medicare Advantage Plans, Private Insurances, and any other payers contracted by SIHF Healthcare.
Assist with monthly delegated credentialing reports to Health Plans and facilitate communication to non-delegated Health Plans to ensure that provider information is correct and current.
Ensure that the information regarding provider’s enrollment into the available health plans is current and up to date and communicated with Medical Staff, Health Centers, and Staff.
Work with supervision with respect to specific objectives; in most tasks and projects assigned, following pre-determined methods, work sequence, scheduling, and how to achieve objectives of assignments; operate within specific policy guidelines.
Perform other duties as assigned.