Credentialing Coordinator I
ALT St Michael - Farmers Bank-15101
2900 St. Michael Dr.
Texarkana, TX 75503
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Serves as a support for the overall management of daily operations of Ark-La-Tex Health Network (ALT) in the absence of the Exectuve Director. Facilitates all aspects of credentialing, including initial appointment, reappointment, and monitoring for all practitioners. Ensures compliance with the accrediting and regulatory agencies (i.e., Joint Commission, NCQA, URAC) in regards to credentialing while developing and maintaining a working knowledge of the statutes and laws. Responsible for the accuracy and integrity of the credentialing database system and for ensuring the timeliness of credentialing/ recredentialing verfication. Conduct extensive background investigations on practitioners including licensure, education and post-graduate clinical training, board certification, disciplinary actions and other professional sanctions, malpractice history, and peer assessment of current competence, in accordance with NCQA, Joint Commission and URAC credentialing standards and other established principles of legal documentation and confidentiality. Ability to analyze administrative problems and to make appropriate recommendations. Ability to develop and maintain effective relationships with the medical staff and other professionals in order to engender confidence, respect and dependability. Ability to maturely handle a variety of problems and situations, sometimes of a critical or urgent nature. Ability to develop and implement methods and procedures for improvement of the comprehensive and specialized credentialing program. Reviews payor Delegated Credentialing Contracts and ensures that ontracts are executed according to ALT policies and procedures and in accordance with NCQA, Joint Commission and URAC credentialing standards and other established principles of legal documentation.
MAJOR RESPONSIBILITIES1. Maintains consistency with Administrative and Departmental policies with appropriate behavior, dress, attitude, attendance, confidentiality, professionalism, and reliability. 2. Serves as a support for the overall management of daily operations of Ark-La-Tex Health Network (ALT) in the absence of the Executive Director. 3. Conducts weekly Huddle meetings. 4. Serves as back up in the absence of the Executive Director in the coordination and approval of staffing requirements and Kronos timekeeping for the PHO. This includes approval of requested time off in order to assure appropriate levels of staffing. 5. Responsible for daily activities of ALT staff insuring work is performed in accordance with ALT Bylaws, Policies and Procedures, as well as NCQA, Joint Commission and URAC standards, and other applicable state and federal regulations. 6. Serves as a resource to the Executive Director, practitioners, office staff, credentialing staff, hospitals, and facilities by resolving credentialing concerns and providing current information regarding NCQA and Joint Commission standards. 8. Responsible for direct supervision of ALT credentialing staff. 9. Establishes and maintains professional relationships with Administration, practitioners and their office staffs, facilities and contracted payers. 10. Coordinates scheduling and preparation for Credentials Committee meetings. Oversee the preparation of minutes, recommendation to Board of Directors, and other documents as required. Attend Board of Directors meetings. Assure that documents are executed properly. 11. Responsible for annual review and maintenance of ALT Bylaws, Policies and Procedures to meet requirements of NCQA and Joint Commission and other regulatory agencies. Insure proper approval process is followed. 12. Responsible for the credentialing process for ALT practitioners, facilities, and ALT-CVO clients. 13. Responsible for the operation of ALT-CVO by insuring the satisfaction of contracted payors and practitioner clients. 14. Reviews payor Delegated Credentialing Contracts and ensures that provider credentialing is executed according to ALT policies and procedures and in accordance with NCQA, Joint Commission and URAC credentialing standards and other established principles of legal documentation. 15. Extensively review and analyze physician provider and credentials documents including certificates of education, residency and fellowship training, and board certification and eligibility; licensure, professional work history, liability insurance and malpractice records. Assess completeness of information and applicants' qualifications relative to established policies and procedures, NCQA, Joint Commission and URAC credentialing standards as required. 16. Extract key information from application materials for purpose of: a) conducting thorough, special follow-up investigations needed in preparation for review by the Credentials Committee and Board of Directors; b) presenting summary to said entities on request; and c) maintaining professional demeanor and confidentiality. 17. Responsible for preparation for delegated credentialing audits of credentials files. Review credentials files in accordance with established principles of legal documentation and confidentiality, and according to NCQA, Joint Commission and URAC credentialing standards, prior to reviews from outside auditors. Assist in audit process and report results to Executive Director and Credentials Committee. 18. Responsible for the integrity of the ECHO credentialing system or other applicable credentialing software. Insure users are appropriately trained and apprised of updates. 19. Using extensive knowledge of credentialing database, develop application/formats of the software system to meet changing data and reporting needs while preserving the logic of the database; enter data from provider applications into database, interpreting or adapting data to conform to defined data field uses. Instruct others in use of new applications/formats. Design custom reports and run data reports for various configurations of data, such as statistical reporting, network credentialing summaries, various physician notifications, appropriate verification and reference letters. Develop new reporting and correspondence formats applying established procedural guidelines. 20. Maintains NAMSS certification through up-to-date knowledge of NCQA, Joint Commission and URAC credentialing standards. Review practices and how they impact credentialing requirements and procedures. Participates in continuing education opportunities regarding credentialing as they are available. 21. Coordinate with appropriate personnel to schedule office site visits, as needed, for appointment and reappointment of ALT practitioners. 22. Work with Medical Director to closely review credentialing information obtained on applicants in preparation for Credentials Committee meetings. 23. Assist the Medical Director with all issues relating to the credentialing process. 24. Oversee and approve quarterly CVO billing. 25. Prepares articles and informational items for bi-monthly newsletter published by ALT. 26. Special projects as requested by Executive Director. 27. Performs any other duties as may be required.
- College degree preferred
- Working knowledge of Joint Commission, NCQA and URAC credentialing standards.
- Must possess and be organized and able to work quickly, independently, and with little supervision.
- Medical terminology recommended.
- Knowledge of ECHO, Word, Excel, and Access preferred.
- Basic Computer Knowledge
- Ability to communicate effectively, both verbally and in writing.
- Related and relevant experience or a demonstrated ability to perform the duties of the position may be considered in lieu of the academic requirements.
- Five years experience in healthcare setting.
- Supervisory experience recommended
- High school diploma or equivalent.
- Attained NAMSS Certification