Credentialing Coordinator - Remote

Job Title: Credentialing Coordinator - Remote
Department: Rush Health
Shift: 1st
Specialty: Credentialing
Job Number: 2023-2519
Date Posted: 07/06/2023
Position Type:

Job Qualifications:

Credentialing Coordinator - Remote

Under the direction of the Manager, the Credentialing Coordinator will have responsibility for coordinating, monitoring, and maintaining the credentialing and re-credentialing of Provider Applicants. This includes facilitating all aspects of appointment, reappointment, and privileging maintenance for managed care, medical staff, and non-physician providers. The Credentialing Coordinator assists in compliance with the contracted managed care payers, accrediting and regulatory agencies (i.e., NCQA, Joint Commission, URAC), in regards to credentialing while developing and maintaining a working knowledge of the organizational guidelines, statutes and laws. Exemplifies the Rush mission, vision and values and acts in accordance with Rush policies and procedures.

Job Responsibilities:
1. Collect relevant and critical data to determine applicant's eligibility to be credentialed.
2. Evaluate and review applications for accuracy and completeness.
3. Gather and conduct verification of confidential healthcare provider credentials.
4. Contact and follow up with contracted managed care payers, Departments, and contracted MSO facilities (RUMC /ROPH) to obtain documentation relevant to the credentialing process and data entry of all credentialing information provided by Departments and contracted MSO facilities.
5. Ensure all expiable are reviewed, obtained and managed on a monthly basis according to rules and policies.
6. Process and record re-credentialing cycles.
7. Maintain the confidentiality of all business, work and credentialing information.
8. Coordinate and prepare reports and packets for the Rush Health Peer Review Committee (PRC) monthly meeting.
9. Assist in managing the flow of information between the managed care payers, contracted MSO facilities and Rush Health.
10. Process and communicate all Rush Health practitioner additions, deletions, and/or changes to all contracted managed care payers.
11. Assist in preparing for managed care credentialing, contracted MSO facility audits.

Required Job Qualifications:

• Two years' of collegiate or industry specific training.
• National Association of Medical Staff Services.
• One year in provider credentialing.
• One year experience in healthcare or managed care industry.

Preferred Job Qualifications:

• Bachelor's degree.
• Three years of relevant work experience in healthcare administration or academic medicine.
• Experience in healthcare or higher education.
• Familiarity with medical terminology.
• Excellent organizational skills and attention to detail.