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Responsible for coordinating, monitoring, and maintaining the credentialing and re-credentialing process within the CVO. Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws relating to credentialing. Responsible for the accuracy and integrity and developing a credentialing database.
Job Responsibility:
Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders
Coordinates and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility
Conducts thorough investigation, research, and primary source verification of all components of the application file
Identifies issues that require additional investigation and evaluation, validates discrepancies, and ensures appropriate follow-up
Reviews necessary documentation and verifications prior to submittal to clients, ensuring turnaround time and quality of data is within required metrics
Responds to inquiries from other healthcare organizations, interfaces with internal/ external customers on day-to-day credentialing/privileging issues as they arise
Meets weekly performance metrics which includes: file completion, quality, and turnaround time
Utilizes and maintains the credentialing database, optimizing efficiency, and performs queries, reports, and document generation
Maintains strict confidentiality of all data and information
Performs miscellaneous job-related duties as assigned
Requirements:
Bachelor’s Degree or equivalent job-related experience
Minimum of at least 3 years of experience related to hospital or managed care credentialing