Credentialing Coordinator

As a Credentialing Professional, you will be responsible for coordinating the credentialing, re-credentialing, and payer enrollment process for providers in accordance with delegated credentialing agreements, policies and procedures, industry best practices, and regulatory requirements.

Every day you will manage daily credentialing operations, including resolution of non-responsive providers. You will also work collaboratively with various clinic managers and the hospital medical staff office to ensure the successful and timely completion of the delegated credentialing and re-credentialing process.

To be successful in this role, you will demonstrate a comprehensive understanding of credentialing regulations and processes, possess strong organizational and communication skills, and effectively manage complex administrative tasks to ensure provider compliance and efficient operational flow.

• Completes all new clinic providers credentialing and /or provides oversight with the privileging process to ensure all necessary documentation is available to grant billing, hospital, and practice privileges. This includes working with providers to obtain information and time-sensitive renewal documentation with the expedient completion of the following, but not limited to:
• Maintains an accurate, current, centralized credential file for all providers in CHI Health.
• Processes all recredentialing requests for CHI Health providers based on regulatory time and content requirements.
• Obtains verification of licensure, malpractice insurance/information/history, etc., required certificates (e.g. medical school diploma, residency training, board certification, etc.) directly from the provider or through communication with the appropriate clinic liaison in a timely fashion prior to initial privileging review by the Medical Executive Officer and CQC.
• Alerts appropriate clinic management staff of potential risks or conflict issues that may arise from any of the privileging, credentialing, and deprivileging processes.
• Notifies the appropriate personnel of revisions in the demographic information of CHI Health providers to maintain the most current data base that may require access by hospital personnel, insurance companies, PHO, etc.

Preferred

• High School GED General Studies, upon hire or
• High School Graduate General Studies, upon hire

From primary to specialty care, as well as walk-in and virtual services, CHI Health Clinic delivers more options and better access so you can spend time on what matters: being healthy. We offer more than 20 specialties and 100 convenient locations; with some clinics offering extended hours.