Credentialing Coordinator

Corewell Health • Southfield, MI

1d • Onsite

About The Position

Under general supervision, this position supports the integrity and effectiveness of the credentialing and privileging in compliance with Medical Staff Bylaws, Rules and Regulations, and all federal, state and licensing agency requirements for initial appointment and reappointment for Beaumont Health and/or managed care. The role provides administrative support for the Credentials Committee, ensuring all credentialing records comply with regulatory and accrediting standards, are up-to-date, and continuously prepared for audits. It facilitates the review of applications by appropriate staff and committees and serves as a resource to Medical Staff leadership, committees, and medical staff regarding the investigation and recommendation decisions for individual credentials and qualifications of physicians and other practitioners/providers. Essential functions include organizing and performing credentialing research and workflow activities for initial appointment and reappointment, tracking applications, preparing documentation for leadership and committee approvals, reviewing and analyzing physician applications, assessing completeness, identifying adverse information, and conducting follow-up investigations. The coordinator maintains accurate, up-to-date confidential credential files, enters data into credentialing software, compiles statistics and reports, prepares materials for Medical Staff leadership and committees, monitors recommendations, coordinates and supports Credentials and Qualifications Committee activities (including agenda preparation, minute recording, and follow-up), prepares recommendations for the Board of Directors, updates databases, manages practitioner/provider privilege requests, and maintains/updates Credentialing Program administrative policy documents. The position also involves documenting and communicating appointee information and requires knowledge of Joint Commission, NCQA, and state standards, handling highly sensitive confidential information.

Requirements

• Associate’s degree or 4 years of credentialing/and/or a combination of credentialing experience/ payor enrollment experience.
• Experience in a hospital setting, minimum one-year credentialing and administrative support knowledge.

Nice To Haves

• CRT-Provider Credentialing Specialist, Certified (CPCS) - NAMSS National Association Medical Staff Services 3 Yrs

Responsibilities

• Organizes, schedules and performs credentialing research and workflow activities required for the credentials verification of initial appointment and reappointment of practitioners applying Beaumont Health Medical Staff; tracks applications and prepares appropriate documentation for the Medical Staff leadership and committee approvals.
• Reviews and analyzes physician applications and credentialing documents.
• Assesses completeness of information and provider’s qualifications relative to established standards.
• Identifies adverse information and conducts appropriate follow-up investigations.
• Maintains an accurate, up-to-date confidential credential file for each physician and advanced practice provider.
• Enters data from applications into the credentialing software database.
• Compiles data and generates a variety of statistics, letters, correspondence and other informational reports for review, verification and decision management.
• Prepares credentialing materials for Medical Staff leadership and Medical Staff committees to review for recommendations to the Medical Staff.
• Monitor recommendations from leadership.
• Coordinates and supports all Credentials and Qualifications Committee activities in collaboration with Medical Staff leadership and Medical Staff committees, including agenda preparation, recording of minutes and follow-up correspondence and reports for the Medical Executive Board.
• Prepares Medical staff credentialing recommendations for presentation to and action by the Board of Directors.
• Update database and send out correspondence.
• Date/time stamp incoming documents and screen for and resolve inconsistencies.
• Identify and flag adverse/questionable information for the purpose of conducting special follow-up investigation for use by the appropriate Medical Staff leadership and Medical Staff committees.
• Researches, documents and reports on individual credentials and qualifications of physicians and other practitioners/providers.
• Manages, tracks and reports on the review and approval of practitioner/provider privilege requests.
• Maintains, reviews and provides updates of the Credentialing Program administrative policy documents to the Credentials Committee, Medical Executive Committee and the Board of Directors.
• Documents and communicates the names, telephones numbers, addresses, staff status, approved privileges, and additional necessary statistical data for new and current appointees.
• Knowledge of Joint Commission, National Committee for Quality Assurance (NCQA) and state standards.
• Exposed to highly sensitive confidential information requires extreme confidentiality.

Benefits

• Comprehensive benefits package to meet your financial, health, and work/life balance goals.
• On-demand pay program powered by Payactiv
• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
• Optional identity theft protection, home and auto insurance, pet insurance
• Traditional and Roth retirement options with service contribution and match savings

What This Job Offers

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