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Credentialing Coordinator Resume Samples
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Candidate Info
8
years in workforce
9
months at this job
BS
Communication
Credentialing Coordinator
Completed complicated hospital privileging forms for physicians performing Locum Tenens work in a timely manner
- Successfully and consistently met deadlines for applications to be returned
- Achieved 100% of goal in first 3 months when expectations were set for around 6 month mark
- Learned how to better communicate with a team of people to ensure timely updates
Candidate Info
7
years in workforce
7
years at this job
BS
Ba
MBA
Business Adminstration
Credentialing Coordinator
- Guided physicians through the credentialing process and enrolled them into required insurance plans providing coverage for services rendered through their offices and [company name].
- Responsible for front to back credentialing process which included new employee onboarding, event driver reviews and periodic reviews.
- Led the process improvement project which reduced credentialing process from 90 to 60 days.
- Utilized electronic credentialing with CAQH to formulate a more standardized process while following NCQA credentialing guidelines.
- Provided feedback and notification to physicians, managers, and coordinators regarding acceptance to payor panels in an organized and timely manner.
- Catalogued all physician practice information, making all necessary changes to physician files, electronic databases and phone directories.
Candidate Info
21
years in workforce
1
year at this job
Billing and Credentialing Coordinator
- Initiated and maintained all Credentialing, Contracting, Licensing and Continuing Education Certificates for all twenty Doctors and Nurse Practitioners.
- Managed and input daily billing for all six clinic locations.
- Reconciled all clinic receivables daily, to track monthly revenue goals for all clinics.
- Awarded bonus for entire department for exceeding billing revenue goals.
Candidate Info
1
year in workforce
1
year at this job
AS
Business To Human Resources
Credentialing Coordinator
- Credentialed/Re Credentialed physicians - Verifications, Background checks, etc.
- Improved and maintained physicians education
- Revised and created templates, reports, and documents
- Trained coworkers on data base systems as well as credentialing procedures
- Helped to improve our Medical Staff Services website
Candidate Info
9
years in workforce
3
years at this job
BA
Healthcare Management
Credentialing Coordinator
- Assisted Anesthesiologists, CRNAs, and Physicians Assistants with credentialing and reappointment applications at healthcare facilities nationally.
- Prepared monthly reports of assigned hospitals and surgery centers to superiors for review.
- Maintained all medical license, drug administration, certifications and malpractice insurance for physicians and mid-level providers nationally.
- Ensured compliance with national standards of quality organizations.
- Audited, data entered, and preformed primary and secondary source verifications
- Resolved practitioner concerns in a timely manner.
Candidate Info
10
years in workforce
2
years at this job
HS
High School Diploma
Credentialing Coordinator
- Primary source responsible for verification updating of provider credentialing information
- Maintained current, accurate, and complete individual provider files
- Monitored and organized paper files to adhere to NCQA accreditation standards.
- Reviewed and completed data entry of credentialing information
- Prepared reports and summaries of all credentialing activities
- Provider Relations
Candidate Info
14
years in workforce
4
years at this job
GED
GED
BA
Healthcare Administration
Credentialing Coordinator/executive Assistant
- Coordinated primary source verifications of initial and reappointment credentialing applications. Ensured credentialing of applicants for membership and appointment was coordinated accurately and timely in compliance with defined schedules.
- Provided administrative support to the Vice-President, Administrator, Clinical Manager, Clinical Coordinator and the Business Office Manager.
- Supervised the business office staff when the management team was out of the office.
- Maintained policies and procedures and updated as changes or new polices were approved by the Governing Board.
- Accommodated all departments in the business office as needed, such as, insurance verification, scheduling, collections, medical records and registration.
Candidate Info
3
years in workforce
2
years at this job
BS
Business Administration
MA
Business Administration
Medical Credentialing Coordinator
- Reviewed provider files for appropriate documentation required for the credentialing process while assuring NCQA and JCAHO compliance
- Collected and maintained files in relation to credentialing of network providers, including application, current physician licenses, DEA licenses, malpractices insurance, board certifications and other pertinent forms
- Maintained credentialing database to ensure data was kept current and accurate
Candidate Info
4
years in workforce
1
year at this job
BS
Management Of Human Resources
MS
Business Management
Credentialing Coordinator
Process and analyze new/billable provider's credentials in all departments to be enrolled with various insurance payers.
- Send applications to provider and to payers for signatures, manage a large amount of provider information at one time.
- Follow up on emails and phone calls with department contacts, enter provider data and follow up information into Symed credentialing database.
- Resolving audit trails and claims edits through ETM.
- Following up on provider information with various insurance payers.
- Training and assisting support reps with online enrollment and verification.
- Experience with EHR Incentive Program, CAQH Provider Database, New Provider Enrollment, ETM through IDX System
Candidate Info
2
years in workforce
1
year at this job
Credentialing Coordinator
- Coordinated and set up meetings, interviews, phone interviews and helped manage the schedule of various employees
- Worked with Clients/hiring managers to get the candidate closed and hired
- Managed all compliance and policy for our branch
- Stayed up to date on contract specific documents for different facilities and tracked credential
Candidate Info
4
years in workforce
10
months at this job
BA
Biology
Credentialing Coordinator
- Manage Clients and travelers credentialing assigned by the supervisor
- Received 100% accuracy from Joint Commission for maintaining and securing files 100%
- Perform work necessary to secure all updated, required paperwork from traveler’s prior start of assignment.
- Perform all criminal background checks and social security checks
- Run expiring credentials report
- Schedule lab appointments through First Lab
- Manage Travel Relation Department Gift Program
Candidate Info
11
years in workforce
2
months at this job
BS
Healthcare Management
Credentialing Coordinator
- Review all provider credentialing and re-credentialing applications for completeness.
- Review and analyze credentialing documents, including education, residency and fellowship training, board certification and eligibility, licensure, professional work history, liability insurance, requests for clinical privileges and malpractice history.
- Assess completeness of information and provider’s qualifications relative to established standards.
- Determine appropriate verification and reference letters to be prepared for adequate processing of each individual application and reapplication.
- Identify and flag adverse information from provider application materials for the purpose of conducting special follow-up investigations.
- Request facility site reviews from appropriate source (i.e. CalOptima) on applicable providers.
Candidate Info
19
years in workforce
2
years at this job
Credentialing Coordinator
- Responsible for oversight of facility and various other applications regarding APP providers (DO, MD, NP, PA).
- Regular interaction with recruiters, medical directors, practice managers, and medical office staff concerning informational and compliant communication related to credentialing of APP providers.
- Analyze and resolve complex provider and medical staff office issues.
- Coordinate and complete enrollment of assigned providers at contracted facilities to ensure the satisfaction of scheduling needs and requirements of the facility's bylaws and medical staff office.
- Serve as a key point of contact regarding credentialing for 13 emergency departments and 3 hospitalist programs in 2 states.
- Assist in developing and maintaining standard operating procedures for the credentialing department.
- Prepare and maintain various reports and summaries of credentialing/re-credentialing activities.
Candidate Info
23
years in workforce
3
years at this job
C
Business
Liberal Arts
Liberal Arts
Credentialing Coordinator
- Verification for Children's Health employed and contracted practitioners in compliance with standards set forth by NCQA, CMS and contracted payers
- Perform primary source verification using pre-approved sources, documenting verification efforts consistent with CMC credentialing policies.
- Submitting accurate and complete provider enrollment applications, following up with payer credentialing departments and provider enrollment representatives to ensure providers are fully credentialed and loaded as participating with all applicable contracted health plans.
- Accountable for maintaining and disseminating accurate plan participation status reports and billing information to all applicable Children's Health internal departments to maximize collections in the revenue cycle management process
- Complete a quarterly roster reconciliation process for all supported practitioners with applicable health plans. Verify accuracy and communicate additions, changes and corrections in a timely manner, along with necessary supporting documentation
Candidate Info
2
years in workforce
1
year at this job
AA
Liberal Arts
BS
Health Administration
Credentialing Coordinator
- Registered new applicants into credentialing software.
- Processed applications and sent verification requests.
- Screened applications and verification requests for discrepancies/red flags.
- Entered response received verification into credentialing software.
- Tracked applications to ensure they were completed and processed appropriately.
- Obtained and monitored credentialing documents that expire.
- Maintained direct contact with Physicians and AHP applicants.
Candidate Info
10
years in workforce
9
months at this job
BA
Business Administration
DHP, Credentialing Coordinator
Ensuring all Emergency Medicine medical personnel are fully credentialed and compliant before gaining both temporary and permanent privileges in hospitals across the United States.
- Compiles and maintains current and accurate data for all providers. As well as, completing provider credentialing, re-credentialing and monitoring/follow-ups for each file.
- Responsible for all primary sourced verifications, clerical and communicative needs between both the physicians, mid-levels and the hospitals. This includes: maintaining copies of current state licenses, DEA certifications, malpractice coverage and any other required credential for every associated provider.
- Sets up and maintains provider information on online credentialing databases and systems.
- Tracks license and certification expirations for all providers to ensure timely renewals. As well as, ensuring all practice information is current with health plans, agencies and other entities.
- Responsible for processing all initial and renewal applications for Healthcare Professionals requesting access to HCA Facilities.
Candidate Info
19
years in workforce
2
years at this job
Clinical Billing
Credentialing Coordinator
- Perform all daily functions of the credentialing and re-credentialing process for multiple Nephrology practices of 80+ practitioners
- Maintain current documents necessary for credentialing
- Research/resolve provider credentialing/enrollment issues with contracted payers
- Update and maintain credentialing database
- Ensure necessary documents are submitted to hospitals, health plans, and dialysis centers in a timely fashion to maintain currrent/active status
- Run regular reports to monitor expirables and obtain updates as needed
Candidate Info
10
years in workforce
6
months at this job
Medical
Credentialing Coordinator
- Perform the initial credentialing functions for contracted providers, which may include collaborating providers, as well as, facilities.
- Maintain timely and accurate data entry and periodically revise provider data in the credentialing database; maintain provider paper and electronic data files for providers; use the CAQH system to collect provider data as required by [company name] to credential individual providers and groups.
- Submit providers with all appropriate documentation to the CVO; monitor and report on progress of each providers credentialing status.
- Maintain rosters of all approved providers/facilities and ancillary organizations for submittal to the Plan Credentialing Committee
- Ensure all providers who require collaboration agreements are appropriately assigned to a collaborating physician and the agreement is executed by both parties; monitor and report progress of each provider.
- Monitor expiring licensure and other dated documents with providers within the prescribed time frames as outlined in the policies and procedures, assisting providers with timely submission and escalating to manager as appropriate.
- Assist with sanction and compliance monitoring and alert Manager of any undisclosed adverse findings immediately.
- Adhere to policies and procedures including timely delivery of completed work and use of resources.
- Identify and analyze any discrepancies, time gaps and other unconventional behavior that could adversely impact the ability to credential the providers and facilities; discover and convey problems to Manager
Candidate Info
14
years in workforce
8
years at this job
BS
Human Services
Credentialing Coordinator
- Collaborate with Port Authority to badge 2,000 tenants for the August Grand Opening of the Westfield World Trade Center retail property.
- Monitor progressing activities throughout the day to obtain an accurate amount of badges issued.
- Conduct daily progress reports for the Westfield Vice President General Manager.
- Communicate with all tenants to help them navigate through the badging process for their employees.
- Process all employees' applications forms into the database system.
- Manage day-to-day calendar.
- Organize files, develop spreadsheets, fax reports and scan documents.
Candidate Info
23
years in workforce
6
months at this job
BA
Business Leadership
Administrative Assistant/accounts Payable/credentialing Coordinator
- Responsible for processing, maintaining and verifying all aspects of credentialing documents for Medical Staff.
- Contacts medical office staff, licensing agencies, and insurance carriers to complete credentialing applications for Cardiologists (5), NP (1) and PA (1).
- Process and records all Accounts Payable & Receivable transactions in QuickBooks online.
- Reconcile Bank Accounts & Credit cards, filing all accounting documents in a timely and organized manner.
- Assist with any financial tasks that are assigned.
- Keep current on department projects, events, and issues and provide updates to supervisor.
Candidate Info
13
years in workforce
6
years at this job
HS
Business
C
Certificate
Credentialing Coordinator
- Meet with new physicians to discuss the credentialing application process
- Ensure all applications and required documents are completed, signed and submitted by deadline
- Responsible for tracking application requests for: Medical Licensure, DEA, Health Insurance Payor ID, National Provider Identification number and Malpractice insurance, NPDB
- Responsible for the data entry and updating of approx. 100 physicians in IntelliSoft (credentialing database)
- Initiated contracts between Coastal Medical and Health Insurance Payors; such as Medicare, BCBS United Healthcare
- Assist with patient billing issues in E-clinical (EMR) software
- Back-up to Receptionist (15-line phone system)
Candidate Info
6
years in workforce
6
months at this job
Credentialing Coordinator
Coordinate all new hire's for MD's, PA's and NP's
- Assist and interact with Physicians on a daily basis
- Updated and kept track of DEA, License and Insurance for Physicians
- Maintain all Physician confidential files
- Update Physician information in credentialing database
- Sent welcome letters to all Physicians, PA's, NP's
- Maintain monthly reports on expired Physician credentials
Candidate Info
9
years in workforce
7
months at this job
BS
Healthcare Administration
Credentialing Coordinator
- Process Provider applications to RMG Credentialing Plan and NCQA specifications.
- Process Ancillary applications to RMG Credentialing Plan and NCQA specifications.
- Assist with the gathering of information required to complete credentialing/re-credentialing cycles for providers of [company name]
- Data entry for credentialing database with current information.
- Prepare and review practitioner files for Credentialing Committee review and decisions.
- Maintenance of provider expireables.
Candidate Info
59
years in workforce
12
years at this job
BS
Management
Credentialing Coordinator
- Responsible for leading, coordinating, monitoring and maintaining the credentialing and re-credentialing of professional medical staff.
- Conducting of thorough background investigations, research and primary source verification of all components of a medical professional's application file.
- Processes requests for privileges, while ensuring compliancy with submitted criteria is outlined in clinical privilege descriptions.
- Responds to inquiries from various healthcare organizations and interfaces with internal and external customers on a day-to-day credentialing and privileging issues as they arise.
- Monitors the initial, reappointment and expirables process of all medical staff, Allied Health Professional staff, other Health Professional staff, and delegated providers by ensuring compliancy with all regulatory bodies.
- Responsible for all aspects of provider enrollment.
Candidate Info
16
years in workforce
3
years at this job
HS
High School Diploma
Credentialing Coordinator
- Coordinate, manage and maintain provider's professional files and documentation
- Research and obtain verification of provider's medical experience and professional references
- Verification of providers' state medical and narcotics license
- Verification of provider's malpractice/claims research
- Assists the medical staff office and provider in the privileging process
- Updates database with demographic and provider's credentialing information for department access
Candidate Info
6
years in workforce
1
year at this job
HS
High School Diploma
National Credentialing Coordinator
- Organize, maintain and verify all aspects of the credentialing process for healthcare clinicians
- Conduct DHS background checks on potential employees
- Assisted in four Express offices becoming Joint Commission certified
- Assist with development of policies/documents necessary for effective credentialing
- Maintain confidential files and adhere to all HIPAA requirements
Candidate Info
14
years in workforce
1
year at this job
BBA
Business Administration And Management
Elementary Education
Sr. Credentialing Coordinator
- Creating a color-coded filing system.
- Communicating with Medical Staff for appointments and re-appointments.
- Identify and monitor potential credentialing coordinator for hiring.
- Respond to all insurance payors requests.
- Managing three (3) staff.
Candidate Info
14
years in workforce
5
years at this job
Certification
Credentialing Coordinator
- Responsible for submitting all New Provider applications to the MCO's, [company name]
- Responsible for submitting all recredentialing/reappointment applications to the MCO's and Hospitals
- Maintain all providers and company license, DEA, and NC Privilege License as well as applying for these license initially
- Responsible for initial and revalidation applications for OrthoCarolina Medicare and Medicaid numbers
- Write Desk Level Procedures for credentialing processes
- Credential MRI Units
- Various other projects as assigned
Candidate Info
25
years in workforce
5
years at this job
AA
Nutrition
Nutrition
Sr. Credentialing Coordinator
- Complete provider and allied health credentialing and privileging to ensure compliance with The Joint Commission
- Administrator of Intellicred credentialing database
- Ensure qualifications of medical staff prior to submitting to the MEC and BOD
- Responsible for training of all new credentialing staff
- Responsible for all initial background checks of providers
- Manager of largest client account
Candidate Info
10
years in workforce
4
years at this job
HS
High School Diploma
BA
Business Administration Finance
Certified Ekg Tech
HR Credentialing Coordinator Manager
- Prepare or maintain employment records related to events, such as hiring, termination, leaves, transfers, or promotions, using human resources management system software.
- Interpret and explain human resources policies, procedures, laws, standards, or regulations.
- Hire employees and process hiring-related paperwork.
- Inform job applicants of details such as duties and responsibilities, compensation, benefits, schedules, working conditions, or promotion opportunities.
- Address employee relations issues, such as harassment allegations, work complaints, or other employee concerns.
- Initiate BGCs according to Sites specific BGC requirements
- Knowledgeable of updated State, local and federal laws regarding employee's Health benefits, employment standards and worker's compensations' family and medical leave
Candidate Info
9
months in workforce
9
months at this job
BA
Business
Criminology And Forensic Technology
Credentialing Coordinator/assistant to The Director of Operations
- Customer service
- Data entry of all customer orders.
- Processed all County, State, [company name] criminal history searches.
- Completed employment verifications, education verification, licensure verifications, malpractice verifications, and reference checks.
- Followed all Pre-employment screening standards as well as the FCRA
- Answered all incoming phone calls
- Processed client invoicing
- Handled all military credentialing files to include all Primary source verifications, and collection of all government required documentation.
- Managed and assisted with all healthcare credentialing for medical professionals as per client expectations.
Candidate Info
6
years in workforce
2
years at this job
Credentialing Coordinator
Compiles and maintains current and accurate data for all providers.
- Verifies entered customer and account data by reviewing, correcting, deleting, or reentering data; combining data from both systems when account information is incomplete; purging files to eliminate duplication of data.
- Completes provider credentialing and re-credentialing applications; monitors applications and follows-up as needed.
- Maintains copies of current state licenses, certificates, malpractice coverage and any other required credentialing documents for all providers.
- Maintains corporate provider contract files.
- Organize and provide documents, reports and information to department and external clients in an useful and well-organized manner
- Create and maintain active files Sets up and maintains provider information in online credentialing databases and system.
- Tracks license and certification expirations for all providers to ensure timely renewals.
- Maintains ASC appointment files, and information in credentialing database.
- Audits health plan directories for current and accurate provider information.
Candidate Info
15
years in workforce
3
years at this job
Supervisory Management Program
Provider Network Support & Credentialing Coordinator
- Facilitate activation, completion and continuous monitoring of provider medical network.
- Communicate daily with healthcare professionals, various internal departments and external vendors.
- Maintain detailed compliance for various government contracts.
- Audit files for accuracy of documentation and components.
- Scan and enter data into customized computer systems.
- Analyze and report on provider compliance.
- Team leader and trainer.
Candidate Info
8
years in workforce
1
year at this job
AS
Medical Office Management
AS
Associate of Science
BA
Business Management
Credentialing Coordinator I
- Ensure credentialing complies with NCQA and URAC to meet federal guidelines and expectations.
- Perform verifications and obtain any missing documents to submit for audit.
- Work special projects, and credential any urgent request in the expected time frame.
- Provide customer service by assisting providers through daily voicemail phone queue.
Candidate Info
5
years in workforce
9
months at this job
BFA
Dance
Credentialing Coordinator
- Leads, coordinates, and monitors the review of practitioner applications and maintain the credentialing and re-credentialing process.
- Conducts thorough background investigation, research and primary source
- Maintains copies of current state licenses, DEA certifications, malpractice
- Utilizes the credentialing database and performs query, submits and retrieves
- Prepares credentials file for completion to be presented to the Medical Staff
- Monitors the initial, reappointment and expirables for all medical staff, Allied
- Responsible for maintaining the Credentials minutes for the Board meetings.
- Performs other duties as assigned.
Candidate Info
4
years in workforce
11
months at this job
HS
High School Diploma
Medical Billing / Coding
Credentialing Coordinator
- Federally Qualified Health Center
- Network Enrollments
- Obtain and Revise Group Contracts
- Arrange Hospital Affiliations
- Renew Provider Licenses
- Create/Update CAQH provider Profiles
Candidate Info
14
years in workforce
1
year at this job
AS
Associate of Science
BA
Health Administration
Credentialing Coordinator
- Responsible for scheduling and on boarding process of applicants
- Assist with McKesson training
- Responsible for the credentialing and privileging functions for all Medical Staff and Allied Health professionals
- Responsible for the following aspects of initial, reappointment and locum process of physicians and allied health professionals
- Request peer review documentation from performance improvement
- Upon completion of file present to Department Chairmen, Credentials Committee, Medical Executive Committee, and Hospital District Board of Directors for approval.
- Maintain a thorough understanding of: Medical Staff organization, bylaws, rules and regulations, JCAHO standards credentialing and privileging procedures and hospital organizational structure
- Schedule/attend monthly meetings, agenda preparation, minute recording, resignations and expireables
- Provide support to Medical Staff Committees, Medical Executive Committee, by laws, and other committees pertinent to credentials
- Maintain computerized database of physician files, generate and present when requested; oversee the maintenance of files
Candidate Info
17
years in workforce
7
months at this job
BA
Bachelor of Arts
Credentialing Coordinator
- Credentialing physicians and allied medical staff in a hospital setting
- Prepare files and attend monthly Credentials Committee Meeting
- Process initial applications
- Compile and maintain current accurate data for all providers
- Manage expirables
- Maintains knowledge of evolving requirements for providers based on medical staff bylaws, CMS and Joint Commission standards
- Communicates with physicians and staff
- Input all information into credentialing database
- Ensure timely renewal of physician appointments
Candidate Info
14
years in workforce
7
months at this job
Certification
Executive Assistant to The CEO, Contract and Credentialing Coordinator
- Supervise daily operations of switchboard and switchboard staff
- Verification and credentialing of 43 Allied Health professionals and Medical Staff
- Ensure the compliance and credentialing files are current and report monthly to Medical Director
- Maintain and update all policies and procedures
- Prepare and expedite corporate contracts for Commercial Insurances, State Agencies, and Foster Care
- Maintain corporate files and records for contract services and vendors
- Arrange travel schedule and reservations for leadership team and CEO
- Schedule and maintain daily appointments for the CEO
- Record and distribute monthly minutes for Management meetings, Medical Executive meetings, and Governing Body meetings
- Perform all other duties as assigned
Candidate Info
22
years in workforce
13
years at this job
Information Technology
Credentialing Coordinator
- Responsible for processing initial and re-credentialing ancillary and physician files for multiple lines of business to support Network need.
- Ensure that [company name]maintains a broad network of qualified providers by accumulating and research specified documents, databases, internet website, etc. for the purpose of credentialing potential and existing providers.
- Work with internal clients and functional departments achieve their objectives by serving as a resource to them in the interpretation, change and application of company policies and procedures.
- Experience with researching, analyzing, maintaining, modifying, validating, and preparing data, information and content which are used in making business decisions, as well as for forecasting, cost planning, positioning, trending, measuring, controlling risk, and contracting.
- Responsible for inventory control and credentialing process flows to include maintaining and distributing CCU Siebel mailbox files for contract request, reworks and taxonomy changes to the credentialing coordinators.
- Responsible for testing the Company's systems that manage business and work processes.
- Test, monitor, manage and evaluate the effectiveness of solutions (company systems), policies, practices and processes to ensure continuous improvement, good client relations, compliance and adherence to business and system requirements. Recommend improvements to achieve and deliver high quality, value-added services.
- Utilize continuous improvement to streamline credentialing cycle time. Independently plan, organize and perform on-going inventory reduction strategies based on changing deadlines.
- Analyze provider data on a monthly basis to the [company name]subsidiary FHCP of approvals, terminations and reworks whereas sanctions and translation of complex court documents and legal proceeding for the monthly peer review and use the data to create any/all communications for providers.
- Ensure credentialing Compliance for all [company name]product lines by adhering to compliance guidelines with various regulatory and licensing agencies such as NCQA, AHCA, JCAHO and CMS including HIPPA policies.
Candidate Info
12
years in workforce
7
months at this job
Medical Credentialing Coordinator
- Leads, coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility.
- Conducts thorough background investigation, research and primary source verification of all components of the application file.
- Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.
- Prepares credentials file for completion and presentation to Health System Entity Medical Staff Committees, ensuring file completion within time periods specified.
- Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and privileging issues as they arise.
- Assists with managed care delegated credentialing audits; conducts internal file audits.
- Utilizes the Cactus credentialing database, optimizing efficiency, and performs query, report and document generation; submits and retrieves National Practitioner Database reports in accordance with Health Care Quality Improvement Act.
- Monitors the initial, reappointment and expirables process for all medical staff, Allied Health Professional staff, Other Health Professional staff, and delegated providers, ensuring compliance with regulatory bodies (Joint Commission, NCQA, URAC, CMS, federal and state), as well as Medical Staff Bylaws, Rules and Regulations, policies and procedures, and delegated contracts.
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