Coordinates all internal and external credentialing activities of the Medical Staff, and acts as a liaison between the Medical Staff and health plan credentialing departments. Maintains primary responsibility for the coordination of credentialing and privileging including: re-credentialing, coordination of peer review (both Focused Professional Practice Evaluations (FPPE) and Ongoing Professional Practice Evaluations (OPPE).

Schedule is Monday – Friday, 8:00am – 5:00pm

Essential Duties and Responsibilities

• Demonstrate effective communication and problem-solving skills.
• Under general supervision of the Director of Provider Recruiting & Retention, coordinates all internal and external credentialing activities of the Medical Staff.
• Maintains knowledge of new and changing accreditation, licensing, and educational requirements and assists in their implementation.
• Participates in the continuous readiness program for The Joint Commission (TJC).
• Facilitates the organization and monitoring of medical staff peer review program including FPPE and OPPE.
• Under the directions of Director of Provider Recruiting & Retention, assists in the medical staff risk management program.
• Responsible for the coordination, arranging and documentation of credentialing committee meetings.
• Responsible for oversight of all credentialing, re-credentialing, and provider enrollment activities.
• Conducts audits and provides feedback to reduce errors, and improve processes and performance.
• Coordinates, supervises and is accountable for the daily activities of Credentialing Specialist.
• Coordination and management of provider data disseminated to health plans and other payors.
• Act as a liaison between medical staff, Recruiting department, HR department, and CMO to facilitate the flow of information.
• Handle confidential information and matters of discretion in a professional manner.
• Prepare and distribute documents and protocols sites related to credentialing.
• Assist with special projects as required by the CMO to assist in corporate administrative functions.
• Tracking and approval of invoices pertaining to primary source verification efforts.
• Other duties as assigned by manager.

Min. Qualifications

KNOWLEDGE OF: Medical Staff Credentialing and Privileging. Prior knowledge of FQHC and/or The Joint Commission credentialing requirements or Certified Credentialing Specialist preferred.

SKILLS: Excellent written and verbal communication; Strong organizational skills with attention to detail, Proficient in MS Word & Excel

ABILITY TO: Meet deadlines and prioritize tasks; to effectively interact with operational and clinical personnel; plan, organize, coordinate, and monitor the work of staff and committees.

Physical Demands

The employee must occasionally lift and/or move up to 25-50 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Work Environment

The noise level in the work environment is usually quiet.

Education/Experience Requirements

• High school diploma or equivalent required.
• Associate Degree in Business Administration or related field preferred.
• Certified Provider Credentialing Specialist (CPCS) or similar certification preferred.
• Three (3) years of medical staff administrative experience.
• Valid CDL and vehicle insurance required.