Credentialing Coordinator

Job description

Job Summary

Under general supervision, this position supports the integrity and effectiveness of the credentialing and privileging in compliance with Medical Staff Bylaws, Rules and Regulations, and all federal, state and licensing agency requirements for initial appointment and reappointment for Beaumont Health and/or managed care.Provides administrative support for the Credentials Committee.

This position ensures that all credentialing records comply with regulatory and accrediting standards, are up-to-date and in continuous preparation for audits.

Facilitates the review of applications by appropriate staff and committees.Serves as a resource to the Medical Staff leadership, Medical Staff committees and medical staff regarding the investigation and recommendation decisions regarding individual credentials and qualifications of physicians and other practitioners/providers.

Essential Functions

+ Organizes, schedules and performs credentialing research and workflow activities required for the credentials verification of initial appointment and reappointment of practitioners applying Beaumont Health Medical Staff; tracks applications and prepares appropriate documentation for the Medical Staff leadership and committee approvals.

+ Reviews and analyzes physician applications and credentialing documents.

Assesses completeness of information and provider’s qualifications relative to established standards.

Identifies adverse information and conducts appropriate follow-up investigations.

+ Maintains an accurate, up-to-date confidential credential file for each physician and advanced practice provider.

+ Enters data from applications into the credentialing software database.

Compiles data and generates a variety of statistics, letters, correspondence and other informational reports for review, verification and decision management.

+ Prepares credentialing materials for Medical Staff leadership and Medical Staff committees to review for recommendations to the Medical Staff.

Monitor recommendations from leadership.

Coordinates and supports all Credentials and Qualifications Committee activities in collaboration with Medical Staff leadership and Medical Staff committees, including agenda preparation, recording of minutes and follow-up correspondence and reports for the Medical Executive Board.

Prepares Medical staff credentialing recommendations for presentation to and action by the Board of Directors.

Update database and send out correspondence.

+ Date/time stamp incoming documents and screen for and resolve inconsistencies.

Identify and flag adverse/questionable information for the purpose of conducting special follow-up investigation for use by the appropriate Medical Staff leadership and Medical Staff committees.

+ Researches, documents and reports on individual credentials and qualifications of physicians and other practitioners/providers.

Manages, tracks and reports on the review and approval of practitioner/provider privilege requests.

+ Maintains, reviews and provides updates of the Credentialing Program administrative policy documents to the Credentials Committee, Medical Executive Committee and the Board of Directors.

+ Documents and communicates the names, telephones numbers, addresses, staff status, approved privileges, and additional necessary statistical data for new and current appointees.

+ Knowledge of Joint Commission, National Committee for Quality Assurance (NCQA) and state standards.

+ Exposed to highly sensitive confidential information requires extreme confidentiality.


Qualifications
Required

+ Associate’s degree or 4 years of credentialing/and/or a combination of credentialing experience/ payor enrollment experience.


+ Experience in a hospital setting, minimum one-year credentialing and administrative support knowledge.


+ CRT-Provider Credentialing Specialist, Certified (CPCS) - NAMSS National Association Medical Staff Services 3 Yrs

About Corewell Health
As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities.

We are committed to cultivating and investing in YOU.

Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope.

Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.


How Corewell Health cares for you
+ Comprehensive benefits package to meet your financial, health, and work/life balance goals.

Learn more here (https://careers.corewellhealth.org/us/en/benefits-new) .
+ On-demand pay program powered by Payactiv
+ Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
+ Optional identity theft protection, home and auto insurance, pet insurance
+ Traditional and Roth retirement options with service contribution and match savings
+ Eligibility for benefits is determined by employment type and status



Primary Location
SITE - Beaumont Service Center - 26901 Beaumont Blvd

Department Name
Credentialing Services - Med Staff CHE - North

Employment Type
Full time

Shift
Day (United States of America)

Weekly Scheduled Hours
40

Hours of Work
8:00 a.m. - 5:00 p.m.

Days Worked
Monday - Friday

Weekend Frequency
N/A

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Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community.

We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category.

We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.


Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.


An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization.

As a health system, we advocate for equity as we care for our patients, our communities, and each other.

From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do.

We invite those that share in our commitment to join our team.


You may request assistance in completing the application process by calling 616.486.7447.

Required Skill Profession

Other General