CREDENTIALS CORDINATOR

POSITION PURPOSE

Under general supervision, supports the implementation of the HVPA and SJMHS Credentialing Manual and maintenance of the physician database. Oversees daily program operations and coordinates processes necessary to provide credentialing/recredentialing documentation, reports and other information to HVPA and SJMHS committees, Boards of Directors, and other customers, and to administer the Credentialing Policy and Procedures and services and delegated credentialing agreements to ensure compliance with credentialing policies and procedures.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

  1. Oversees daily operation of the credentialing/recredentialing program for new members and new HVPA providers, following the guidelines as identified in the Credentialing Manual.
  2. Coordinates the credentialing/recredentialing process, including initializing the process, identifying physicians, monitoring, follow-up on required documents, regular reporting of status of initial credentialing/reappointmentto Department Chairs and Credentials Committee.
  3. Maintains and updates confidential physician files.
  4. Maintains MSO database and ensures mailing addresses, telephone numbers, and participation in various managed care organizations and other key demographics.
  5. Fields telephone calls regarding managed care products, credentialing/recredentialing procedures, etc.
  6. Maintains primary contact between the clinical Departments and the Committees.
  7. Completes final review of recredentialing applications prior to Committee presentation to ensure complete and accurate files, and acts as support person for the Credentialing Specialists regarding questions and concerns on applications.
  8. Assists Director with development of Network Credentialing Manual and Policies and Procedures.
  9. Works closely with the Director of Credentialing to oversee general department operations.
  10. Assists in identifying and developing reports to allow for ongoing monitoring of Credentialing activities.
  11. Responds appropriately to time-sensitive requests (critical staffing privileges, visitor and observer privileges).
  12. Screens application requests in controversial issues.
  13. Offers assistance and support to Credentialing Department Director.
  14. Participates in professional development programs and professional organization to grow in understanding of various regulations and legislation of health care industry as appropriate.
  15. Maintains good rapport and cooperative relationships. Approaches conflict in a constructive manner. Helps to identify problems, offer solutions, and participates in their resolution.
  16. Maintains the confidentiality of information acquired pertaining to patient, physicians, employees, and visitors to St. Joseph Mercy Health System. Discusses patient and hospital information only among appropriate personnel in appropriately private places.
  17. Behaves in accordance with the Mission, Vision and Values of St. Joseph Mercy Health System.
  18. Assumes responsibility for performance of job duties in the safest possible manner, to assure personal safety and that of coworkers, and to report all preventable hazards and unsafe practices immediately to management.

OTHER FUNCTIONS AND RESPONSIBILITIES

Performs other duties as assigned.

REQUIRED EDUCATION, EXPERIENCE AND CERTIFICATION/LICENSURE

  1. A Bachelors degree or equivalent combination of education, training, and/or experience in health care administration or a related field.
  2. Five (5) years of health care experience.
  3. Qualify as a candidate for CPCS or CMSC certification by the National Association Medical Staff Services.

REQUIRED SKILLS AND ABILITIES

  1. Strong communication skills including the ability to correspond effectively, as well as verbally convey information clearly, listen actively, and consider varying viewpoints when making decisions.
  2. General understanding of the current health care environment, including familiarity with managed care concepts and integrated delivery systems.
  3. Strong organizational skills and the ability to provide attention to detail and complete work in a thorough manner.