Credentialing Coordinator

Job description

POSITION SUMMARY: The full-time Medical Department Credentialing Coordinator serves and advocates for clinicians and provides administrative support to the Medical and Quality Assurance Departments. He/she serves as Credentialing Manager for Esperanza, coordinates provider on and off-boarding and manages the department budget.
ESSENTIAL FUNCTIONS
Credentialing
• Guide clinicians (and other licensed professional staff including BHC, Dentists, Nurses, and Dieticians) through the credentialing, privileging, and re-credentialing processes.
• Internal Credentialing
• Request, gather, and maintain on file all relevant documentation for internal and external provider/staff credentialing
• Create, maintain, and update credentialing reports and spreadsheets.
• Governmental Licensing
• Coach clinicians in how and when to apply for licenses.
• Submit initial supervision agreements (PA’s) and prescriptive authority applications (CRNP’s) for midlevel practitioners with state medical and nursing boards. Take lead in keeping up to date with changing requirements.
• Maintain on file collaborative agreements for CRNP’s.
• Prepare and submit credentialing applications for new clinicians with Medicaid and Medicare.
• Insurance/External Privileging
• Prepare and submit privileging applications for new clinicians with insurance companies.
• Request and maintain hospital privileges for applicable clinicians.
• Maintain a filing system that allows for timely retrieval of requested information.
• Keep a constant flow of communication between the insurance companies, hospitals, malpractice companies and medical billing agencies, to ensure EHC is in compliance with all state, city and federal regulations.
• Research and resolve any and all credentialing issues.
• Update and inform Medical Director, Dental Director, Behavioral Health Director, HR Director, Executive Director, and Billing Manager of any issues, changes in policies and/or provider status changes that may arise unexpectedly.
• Keep a professional and friendly relationship with all network representatives.
• Re-credentialing
• Manage the internal re-privileging process for clinicians and other licensed professional staff every two years (concurrent with the renewal date of providers’ licenses).
• Create and maintain Council for Affordable Quality Healthcare (CAQH) profiles for billable practitioners in coordination with the Dental and BHC departments.
• Support clinician completion of continuing medical education requirements and reimbursements within Esperanza guidelines.

Medical Director and Clinician Leadership Support
• Support projects of Medical Director, Site Medical Directors and Associate Medical Directors as needed and as available.
• Know and communicate Medical Department policy to clinicians and staff when appropriate. Assist with drafting, editing, compiling, and formatting medical department policy and procedure.

Clinician Support
• Provide spiritual support, encouragement to clinician staff as needed
• Take initiative to check in with clinicians (especially at K&A), advocate for clinician wellbeing and concerns, and work toward resolution of any problems that arise.
• Respond to clinician communication in a timely fashion.
• Coordinate ACLS and BLS training for medical clinicians every 2 years.

Human Resources
• Participate in clinician screening and interviewing.
• Occasionally assist with clinician recruiting at conferences, career fairs, and other events.
• Communicate in a timely fashion with HR about clinician start dates, FMLA’s, leaves, and FTE changes.
• Coordinate and plan staff retreats with HR, as needed.
• Coordinate onboarding for oncoming clinicians, communicating with HR, IT and appropriate departments
• Coordinate exit process for departing clinicians including sending farewell letters to patients, scheduling a goodbye dinner, communicating with HR and appropriate departments, and overseeing patient reassignment in collaboration with Medical Department Administrator.

Additional Responsibilities
• Help to cover tasks during absences of Medical Department Administrator.
• Coordinate tracking and maintenance of Athena Billable license count, working with IT and Finance to ensure that appropriate number of licenses are maintained
• Coordinate access to external EMR systems

Budget Management
• Manage departmental budget, track expenses, and ensure timely reimbursements.
• Prepare monthly credit card usage report.
• Project department expenses for annual budget proposal.

COMPETENCIES
• Demonstrates Godly character and lifestyle in keeping with authority of the Bible
• Self-directed and motivated.
• Exceptional organizational and interpersonal skills, with attention to detail required.
• Independent thinker and good problem-solver.
• Strong oral/written communication is required. Establishes and maintains open lines of communications with other staff.
• Ability to work collaboratively in a team and manage multiple priorities, utilize effective time management skills, and exercise sound administrative judgment.
• Ability to analyze systems and to develop creative solutions to problems.
• Demonstrated ability to work well with people of various ages, backgrounds, ethnicities, and life experiences.
• Mature, well-spoken. Maintains discretion and confidentiality in communicating with others.
• Wisdom and courage to evaluate candidates in a way that preserves Esperanza’s mission and honors and respects those who may not be good fits.
• Communicates the love of Christ through interactions, not complaining or arguing, but expressing hope in Christ and His promises.
• Seeks to serve Christ and proclaim the gospel in word and deed.

KNOWLEDGE, SKILLS, AND QUALIFICATIONS
• Bachelor’s degree preferred.
• NAMSS certification preferred.
• At least 1-2 years of administrative experience preferred.
• Bilingual English/Spanish preferred.
• Experienced with MS Word and Excel.

WORKING CONDITIONS
• Must be able to work in regular office environment.