Coordinator Credentialing Senior - Health Plan Enrollment

Summary:

The Coordinator Credentialing Senior serves as the first line of defense through the functions of providing for adequate and qualified staff. Under supervision of leadership, the Coordinator Credentialing Senior is responsible for the department. Duties include ensuring compliance with regulatory and accrediting agencies, interpreting standards, and identifying, recommending and implementing changes. This position serves as the liaison between administration and staff on matters such as medical staff credentialing. This includes, but is not limited to, verification of education and training, certification and clinical practice credentials. The Coordinator Credentialing Senior demonstrates leadership through the role of advisor to staff and administration in understanding and applying standards. This position is responsible for developing and maintaining all aspects of the credentialing function. Incumbent will demonstrate broad knowledge of the business and leadership ability to warrant role model status to others with relevant roles within the organization. The Coordinator Credentialing Senior is able to advise the medical staff leadership on matters of priority in an expeditious manner and can instruct them in the responsibilities of their positions with respect to credentialing and help bring them up to date on current issues involving regulatory agencies, clinical privileges, or standards of care. Must demonstrate sufficient empowerment skills to successfully assume and maintain at least one major project as assigned by administration. Assigned projects are strategic in nature and long term in responsibilities. The Credentialing Coordinator Senior should demonstrate strong organizational skills and assertiveness in problem solving.

Responsibilities:

• Responsible for all aspects of credentialing
• Serves as role model and mentor to others in interfacing relevant roles
• Preceptor to others in duties related to credentialing
• Cross trains other staff for major job responsibilities as appropriate for optimum functioning
• Serves as liaison between staff and administration
• Oversees credentialing activities
• Precepts and mentors designated staff personnel
• Coordinates staff with regulators
• May facilitate staff meetings
• May be responsible for the preparation of meetings, including production of agenda, documents for review and for personal review and preparation of staff in advance, as needed to facilitate informed participation.
• May be responsible for accurate and timely recording of meeting minutes.
• Assists staff in enforcing bylaws, rules and regulations, policies and procedures, and identifies /communicates the need for revisions and additions.
• Tracks current licensure required for staff.
• May record and track meeting attendance as required by staff bylaws for maintaining staff status.
• May provide support for staff and administration for Due Process Proceedings by attending hearings and appeals meetings and recording proceedings.
• Tracks monitoring/proctoring documentation necessary for the granting of special or new privileges to staff.
• Updates the database for the credentials, and keeps computer system current.
• May help coordinate staff functions
• Follows the CHRISTUS Guidelines related to the Health Insurance Portability and Protected Health Information ACT (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI).
• Collaborate with all other departments as appropriate and required to facilitate the completion of tasks/goals.
• Responsible for all aspects of compliance with the standards of credentialing and accrediting bodies.
• Communication, Coordination, Collaboration with all customers, internal and external
• Responsible for at least one major project that contributes to the strategic initiatives of the department.
• Serves as Liaison to staff in matters of credentialing and related issues.
• Manages projects and timelines to achieve highest quality work within allotted period.

Requirements:

• High School Diploma Required
• 3 Years Related Experience Preferred
• Certified Provider Credentialing Specialist (CPCS) or Certified Medical Staff Coordinator (CMSC) Preferred

Work Type:

Full Time

EEO is the law - click below for more information: 

https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12ScreenRdr.pdf

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