Credentialing Coordinator (Hospital Credentialing exp / CVO exp preferred)

JOB SUMMARY:
Completes timely and accurate credentialing of providers with minimal guidance. Ensures that credentialing records comply with requirements of regulatory and accrediting agencies including The Joint Commission (TJC), National Committee for Quality Assurance (NCQA), federal and state laws and delegated credentialing agreements.


KEY RESPONSIBILITIES:

• Ensures all individuals meet qualifications of The Joint Commission and NCQA Credentials Verification Organization (CVO) standards as well as other regulatory requirements and agreements.
• Works proactively to resolve issues before providers and/or patients are impacted.
• Performs primary source verification for applicants.
• Collaborates with personnel in other departments and organizations.
• Ensures appropriate documentation is maintained and that information is easily retrievable.
• The responsibilities listed are a general overview of the position and additional duties may be assigned.

TECHNICAL CAPABILITIES:

DATA ENTRY (INTERMEDIATE): - The ability to transcribe information from the original source into an electronic system according to written and verbal instructions efficiently and accurately.

ANALYTICAL SKILLS (INTERMEDIATE): - The process of identifying, evaluating, interpreting and organizing data. It includes sorting through data to identify patterns and establish relationships for decision making.

DISCRETION & PRIVACY (INTERMEDIATE): - The ability to use and keep information confidential in a secure setting.

CVO POLICIES AND PROCEDURES (NOVICE): - Knowledge, adherence and application of CVO policies and procedures.

CORE ACCOUNTABILITIES:

• Organizational Impact: Performs non-routine tasks that significantly impact team's performance with minimal guidance.
• Problem Solving/ Complexity of work: Conducts research and analysis to solve some non-routine problems.
• Breadth of Knowledge: Applies broad job knowledge and has basic job skills in other areas.
• Team Interaction: Provides informal guidance and support to less experienced team members.