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Credentialing Coordinator III

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University of Rochester

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Location:
United States of America , Rochester

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Category:
Health and Beauty

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Contract Type:
Not provided

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Salary:

23.06 - 32.29 USD / Hour
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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

Additional Information:

Job Posted:
February 21, 2026

Employment Type:
Fulltime
Work Type:
Remote work
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