Credentialing Coord - Expirables Mgmt - Phys Office Risk Management
Phys Office Risk Management
Under the general direction of the Senior Director of the Credentialing Verification Office with daily activities supervised by the Credentialing Manager, this position focuses on and is responsible for tracking all credentials that have an expiration date to ensure they are renewed by practitioners prior to expiration for all Active Medical Staff at a Steward Hospital.
Responsibilities include, but are not limited to:
* Generate Cactus reports monthly to identify all documentation and credentials that are due to expire. Filter, sort and summarize the list based on current requirements.
* Prepare and send authorization forms, if applicable.
* Directly communicate with provider or credentialing contact in advance of expiration dates to obtain the expired document or credentialing information and request updated documentation.
* Follow up in accordance with established schedule to ensure timely receipt of requested documentation or credentialing information.
* Track receipt of documentation and verify with primary source or other methods acceptable under The Joint Commission, NCQA, state or federal regulations or Medical Staff Bylaws.
* Process expiring criminal background checks by entering information from consent form into background screening website.
* Notify Manager when provider fails to respond to requests to renew credentials at least 30 days prior to expiration.
* Monitor provider credentialing/recredentialing privilege dates to ensure privileges remain current.
* Assisting the department with related credentialing duties as necessary and time allows.
· Strong organizational, problem solving, and prioritization skills as demonstrated by the successful and timely completion of assignments.
· Excellent verbal and written communication skills, ability to interact with all levels of personnel
· Keen attention to detail
· Experience working in a team-oriented, collaborative and matrix environment
· Working knowledge of Microsoft Office, Skype and other software used in daily work
· Knowledge and understanding of NCQA and TJC standards, NPDB guidelines, hospital policies and procedures, and general licensing regulations.
· Education: Bachelor's degree or equivalent education & experience
· Experience: Three or more years of credentialing experience in a managed care plan, or hospital medical staff services department desired.
Job Status: Full Time
Job Reference #: 48387