Health System Credentialing Coordinator

Work schedule: Monday-Friday day shift hours Work Type: In-person

What to expect.

Provides administrative services to support the credentialing/privileging process for all Medical Staff clinicians including psychiatrists physicians dentists psychologists social workers nurse practitioners and physician assistants. Processes credentialing/re-credentialing materials and membership applications tracks progress of credentialing reviews by credentialing committees Medical Executive Committee and Board of Trustees. Monitors contents of application packets to ensure completeness researching problems that impact timely credentialing and privileging. Interfaces with clinicians Program Directors Affiliate Directors and Administrators regarding the credentialing status of clinicians. Establishes and maintains database of credentialing categories and expirations of licenses insurances board certification CPR and the like. Collects data prepares reports and provides administrative support for Medical Staff activities and programs. Organizes Orientation for P.A. clinicians. Represents Director in matters regarding The Joint Commission and Disaster Planning as necessary.

Specific responsibilities include:

1. Customer Relations

• Actively seeks to provide quality services that meet the needs of clinicians clinical and administration leadership Sheppard Pratt and Division of Professional Services staff as well as patients families and external professional associations

2. Credentialing Appointment & Reappointment Processes

• Oversees credentialing process for all Medical Staff clinicians active courtesy and consulting staffs.
• Maintains current files per The Joint Commission (TJC) and State of Maryland requirements.
• Prepares appropriate files for Credentialing Committee Medical Executive Committee and Board of Trustees review.
• Maintains ECHO database for all clinicians generating reports queries letters and lists as needed.
• Analyzes functionality of ECHO to enhance effectiveness and efficiency of the credentialing process and follows up with internal and external Information Technology resources as appropriate.
• Tracks expiring licenses certifications and insurances providing notices to clinicians and supervisors at least two months prior to expiration.
• Provides updates to Director regarding status of credentialing files for both appointments and reappointments.
• Requests Temporary Privileges per policy.
• Requests Expedited Privileging per policy.
• Compiles State of Maryland updates every six months regarding privileges of physicians.

3. Policies & Procedures

• Maintains Department of Psychiatry & Medicine Psychology and Masters Prepared Clinician policies procedures and Bylaws.
• Follows through to effectuate revisions to policies procedures and Bylaws based on the recommendation of the Medical Executive Committees.
• Ensures presentation of revisions to Board of Trustees for approval and that signed policies are current and available at all times.
• Communicates with Medical Staff regarding Bylaw changes.
• Develops and implements credentialing practices and procedures for Directors approval according to licensing regulatory and accreditation requirements.

4. Problem Resolution

• Researches and resolves problems related to credentialing and privileging.
• Audits files to ensure that all P.A. clinicians have appropriate privileges.

5. Fiscal Administration

• Manages and pays clinician and hospital dues for the Departments of Psychiatry & Medicine and Psychology.
• Manages payments for service through the National Practitioners database and to obtain primary source verifications and claims histories.

6. P.A. Orientation

• Coordinates and schedules programs to effectively orient newly hired P.A. staff to P.A. and Sheppard Pratt interfacing with new employee orientation participants and clinical & administrative supervisors.

7. Managed Care/ Administrative Support

• Supports Division goals and objectives by collecting data; preparing reports.
• Provides other administrative support as required.
• Works closely with Managed Care Coordinators to ensure completeness of clinician files for pre-delegation and annual delegated agreement audits.
• Creates and maintains ECHO tracking mechanism for use by Managed Care Coordinators.
• Provides documentation and responds to credentialing inquiries during MCO delegated audits.
• Works with Director to prepare auditor-recommended policy changes to comply with NCQA and CMS requirements to ensure continuation of delegated MCO agreements.
• Coordinates Annual Meeting of the DPM preparing and disseminating agenda purchasing gifts ordering equipment and meals and preparing comprehensive minutes for approval of Chair DPM.

What youll get from us.

At Sheppard Pratt you will work alongside a multi-disciplined team led by a bold vision to change lives. We offer:

• A commitment to professional development including a comprehensive tuition reimbursement program to support ongoing education and licensure and/or certification preparation
• Comprehensive medical dental and vision benefits for benefit eligible positions
• 403b retirement match
• Generous paid-time-off for benefit eligible positions
• Complimentary Employee Assistance Program (EAP)
• Generous mileage reimbursement program

The pay range for this position is $24.0814 minimum to $37.1830 USD maximum. Pay for this position is determined on a number of factors including but not limited to years and level of related experience.

What we need from you.

1. Work requires knowledge of behavioral health and the credentialing and privileging function The Joint Commission (TJC) and NCQA requirements the ability to effectively communicate both orally and in writing and strong computer skills including Excel and Word - acquired through high school education and two to three years of administrative work experience. Bachelors degree and prior healthcare experience are preferred.
2. Work requires interpersonal skills sufficient to communicate effectively with P.A. clinicians clinical and administrative leadership professional organizations members of the insurance community information technology staff in external organizations and other internal staff (21%-50% of work time).
3. Work requires proven project/program and problem-solving administrative skills using Word Excel and ECHO.
4. Work requires the ability to prioritize workload planning for cyclical as well as daily tasks/events meeting deadlines responding promptly to critical organizational/program issues and managing the demands of multiple projects very frequently (51%-80% of work time) produces a great deal of mental/visual stress and fatigue.

WHY SHEPPARD PRATT
At Sheppard Pratt we are more than just a workplace. We are a community of healthcare professionals who are dedicated to providing hope and healing to individuals facing lifes challenges. Join us and be a part of a mission that changes lives!

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Required Experience:

IC