Lead Credentialing Coordinators work with providers applying for appointment or reappointment to the medical or professional staff of any single or combination of Fairview or HealthEast entities. Ensure timely and smooth completion of process. Ensures all processes meet Joint Commission (JC) and National Committee for Quality Assurance (NCQA) standards. Assists and works with team members to address questions regarding processing of files, problem solving, identifies and assists with opportunities for improvement in credentialing processes, and develops new processes. Process identified red flag issues. Provides initial training to new employees and on-going training and development to employees. Analyzes applications to complete quality reviews on new employees and other employees as assigned. Utilizes statistics and quality review reports to develop on-going training and to provide feedback to employees. Assists in assigning work to team members. Assists with departments performance improvement processes and implementation of changes. Completes special projects as assigned.
Assists team members with questions regarding processing of files; problem solves issues according to established guidelines.
Identifies opportunities for improvement in credentialing processes; works with team members to develop new processes.
Provides training to new employees and to current employees on new processes.
Ensures sources for primary verification sources such as NPDB, AMA, ABMS, ECFMG, etc. are current and meet JC and NCQA standards; researches new primary verification sources as requested.
Assists in maintaining department databases, associated files and records on a regular basis according to established policies and procedures.
Maintains general knowledge of Fairview System Credentialing Office policies and procedures, JC and NCQA accreditation standards, and credentialing policies for Fairview entities
Assures confidentiality of all data is maintained
Assists with other duties as assigned
Two years business or technical college degree or 2 years of credentialing related experience
One year experience in a credentialing related position; would consider appropriate similar experience.
Bachelors degree in Business or a Health Care related field. Medical Terminology.
Three years of hospital credentialing experience
CPCS or CPMSM certification by the National Association of Medical Staff Service
Requires excellent organizational skills, attention to detail, and strong professional written and verbal communication skills. Ability to use independent judgment to perform a wide variety of tasks in a professional way. Critical thinking skills to integrate data critical information, recognize and address issues to arrive at effective solutions. Ability to develop and train employees with skills of breaking down problems into simple tasks or activities. Effective management of deadlines, and work load prioritization. Varied PC, database and word processing ability with accuracy required.
Together with the University of Minnesota and University of Minnesota Physicians we have created M Health Fairview. M Health Fairview is the newly expanded collaboration among the University of Minnesota, University of Minnesota Physicians, and Fairview Health Services. The healthcare system combines the best of academic and community medicine — expanding access to world-class, breakthrough care through our 10 hospitals and 60 clinics.
Fairview Health Services (fairview.org) is an award-winning, nonprofit health system providing exceptional care across the full spectrum of health care services. Fairview is one of the most comprehensive and geographically accessible systems in the state, with 10 hospitals—including an academic medical center and long-term care hospital—serving the greater Twin Cities metro area.
Its broad continuum also includes 60 primary care clinics, specialty clinics, senior living communities, retail and specialty pharmacies, pharmacy benefit management services, rehabilitation centers, counseling and home health care services, medical transportation, an integrated provider netwo...rk and health insurer PreferredOne. In partnership with the University of Minnesota, Fairview’s 32,000 employees and 2,400 affiliated providers embrace innovation to drive a healthier future through healing, discovery and education.