Credentialing Coordinator III Job at University of Rochester (Rochester)

Job Description

Participates in departmental activities to ensure quality in conducting, maintaining, and communicating the medical and allied health professional staff credentialing, privileging, and primary source verification process. Serves as a resource of the department, and collaborates with other team members to advance the quality of practitioners and patient safety of the facility.

Job Responsibility

Determines practitioner eligibility for membership/participation
Analyzes application and supporting documents for accuracy and completeness and informs the practitioner of the application status
Obtains, researches, and evaluates information from primary sources to ensure compliance with accreditation and regulatory standards
Recognizes, investigates, and validates discrepancies and adverse information obtained during the application process
Processes requests for privileges when applicable
Monitors the initial and reappointment process for all Medical and Allied Health Professional staff
Monitors the status of completed files in departmental review and/or committee review until final approval
Monitors personal performance statistics related to accuracy and productivity
Reviews performance measures and goals with auditors and management regularly
Collaborates and coordinates activities with the Credentialing Managers and staff
Collaborates with various departments and key stakeholders to ensure all policies and standards are met
Communicates the status of applicant files directly to providers and various department representatives
Communicates the status of expiring credentials directly to providers and various department representatives
Serves as a resource for departments and clients pertaining to medical staff bylaw, policies, and procedures
Responds to inquiries from other healthcare organizations
In collaboration with management, reviews and assesses departmental functions and services to identify areas in need of improvement
Assists with various aspects of the credentialing expirables process
Represents the Medical Staff Services Department for various initiatives and/or committee meeting as needed
Serves as back up to other credentialing staff as needed
Serves as a Team Peer Interviewer as needed
Other duties as assigned

Requirements

Associate's degree in business or healthcare related field and 2 years of medical administrative experience required
Or equivalent combination of education and experience
1 year of medical credentialing and/or payer enrollment experience preferred
Fluent English language skills (oral and written) required
Proficiency in MS Office (e.g. Word, Excel, and PowerPoint), email, internet required
Knowledge of and experience with Joint Commission, CMS, and NCQA Regulations related to medical staff services and Commercial Payers Credentialing preferred
Knowledge of and experience with database applications preferred
Exceptional interpersonal and communication skills preferred
Ability to develop and maintain relationships with a variety of key stakeholders across the organization preferred
Certified Medical Professional Services Management (CPMSM) upon hire preferred
Certified Provider Credentialing Specialist (CPCS) upon hire preferred

Nice to have

1 year of medical credentialing and/or payer enrollment experience
Knowledge of and experience with Joint Commission, CMS, and NCQA Regulations related to medical staff services and Commercial Payers Credentialing
Knowledge of and experience with database applications
Exceptional interpersonal and communication skills
Ability to develop and maintain relationships with a variety of key stakeholders across the organization
Certified Medical Professional Services Management (CPMSM) upon hire
Certified Provider Credentialing Specialist (CPCS) upon hire

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Credentialing Coordinator III

Job Description

Job Responsibility

Requirements

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