JOB PURPOSE: The Credentialing Coordinator processes applications for potential healthcare providers, ensuring the supporting documentation is complete. The Credentialing Coordinator also verifies that each provider’s application information is accurate while adhering to internal policies and procedures and external regulatory requirements. In addition to processing applications, tracking license and certification expirations the Credntialing Coordinator will ensure providers fulfill their renewal requirements. This role is essential to preserving the confidentiality and safety of our patients by following all federal and state regulations as well as El Rio Health internal policies. Ensures healthcare professionals and services meet all established federal and state standards, as well as all appropriate regulatory body requirements.
Essential Job Functions: • Processes initial and recredentialing applications and reappointment, checking for full completeness and accuracy. • Collects and verifies required credentialing and recredentialing documentation, including, but not limited to primary source verification, licensure, and regulatory databases. • Preserves the confidentiality of provider information and records through proper credentialing. • Tracks license and certification expirations to confirm renewals. • Maintains accurate information for all providers, updating their credentials as necessary. • Complies with external audits. • Maintains regular cooperation and compliance with all regulatory, accrediting, and membership-based organizations. • Implements and carries out internal credentialing processes related to licensed independent providers. • Ensures that all personnel and services adhere to facility and staff policies, department guidelines, regulations, and government laws. • Prepares records for regular auditing, as well as maintains close communication with all appropriate practitioners to ensure that records are up-to-date and consistent. • Identifies discrepancies in information and conducts follow up. • Conducts data analysis and evaluations of all completed credentialing files. • Performs all assigned administrative projects, duties, tasks, responsibilities, and assignments supporting organizational operations within established time frames; meeting established rates of performance for the quality and quantity of work for the position; demonstrating a level of self-initiative, quality, efficiency, and accuracy in the employee’s job performance that ensures the highest standards of excellence. • Understands and complies with all organizational Code of Conduct standards, Policies and Procedures, and Service Excellence requirements with all patients, visitors, employees, and internal/external clients or representatives. • Maintains a clean, safe, and hygienic work environment in compliance with all Policies and Procedures including but not limited to work areas, workstations, examination rooms, hand washing, infection prevention and control etc. for this position. • Demonstrates an understanding of and proficiency with the application of all compliance and reporting requirements respective to Joint Commission Certification (JCC) standards. • Serves as a contact point and informational resource for credentialing operations; tracking and ensuring that any issues, complaints, problems, or requests are brought to a timely and effective resolution. • Demonstrates the comprehensive and specialized knowledge, understanding, and technical skills of organizational credentialing operations to complete all assigned administrative projects, duties, tasks, responsibilities, and assignments, such as: ◦ Successfully performs all functions utilizing organizational operating systems, programs, and/or business software. ◦ Generates and distributes scheduled, or ad hoc system reports and/or summary information, as assigned or requested for departmental leadership or staff, as well as other internal/external clients or representatives through utilization of available reporting programs linked to credentialing databases, programs, or systems. ◦ Serves as project coordinator for small team projects; handling matters proactively, expeditiously, and following-through to successful completion of the project. ◦ Anticipates requirements and opportunities to create credentialing operational efficiencies and develops creative solutions for achieving them. • Maintains organizational, employee, and/or patient confidentiality by controlling the environment and information being disclosed to authorized individuals ensuring compliance with all HIPAA and corporate compliance standards, as well as generally accepted human resources confidentiality standards. • Demonstrates an exceptional level of customer service; answering and responding to all incoming calls, emails, and inquiries in a timely and effective manner, responds to requests for support providing general information in response to inquiries; referring technical inquiries or complaints to the appropriate department member for resolution, when required. • As a team player demonstrates self-initiative by being aware the work environment to assist co-workers and others while maintaining and enhancing a respectful and positive attitude in the work environment.
Minimum Education and Experience: • Associate degree in Public Health or directly related field from an accredited college or university. • Three (3) years’ experience of Credentialing or healthcare administration experience.
If applicable, equivalent combination of education and experience may be considered, and must be directly related to the functions and responsibilities of the job.
Required Licenses, Certifications, and Registrations: • Level I fingerprint clearance card: current valid and in good standing or have applied for it within seven working days after beginning employment. • Employees in this position are required to have reliable transportation that can meet any operational reassignments of the organization during the workday. If an employee is driving during work hours, the employee is required to possess a valid driver’s license and must comply with Arizona vehicle insurance requirements.
Preferred Education, Experience, Skills, Abilities: • Bachelor’s Degree in Public Health or directly related field from an accredited college or university. • Five (5) years’ experience in credentialing or healthcare administration. • Certified with the National Association Medical Staff Services • Bilingual (English/Spanish) with the ability to speak, read and write in both languages. Reasonable accommodations may be made to enable individuals with disabilities; known limitations related to pregnancy, childbirth, or related medical conditions; and for sincerely held religious beliefs, observances, and practices to perform the essential functions of the job. El Rio Health does not discriminate based on race, color, religion, sex (including pregnancy, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, or other non-merit-based factors. It is our intention that all qualified applicants be given equal opportunity and that selection decisions are based on job-related factors. El Rio Health requires all AZ employees to have a Level One Fingerprint Clearance card. A.R.S. 36.425.03. New hires and transfers must submit their fingerprint clearance card or fingerprint receipt before their hire date or transfer date. Level One (1) Non-IVP Fingerprint Clearance card must be received within 30 days after the new employee hire date or transfer date. All employees are strongly recommended to obtain and maintain vaccination status (i.e., as recommended by CDC and/or other public health agencies) to include an Influenza vaccination. Subject to exemptions and accommodations when required by law. (Policy: Adm-016 & Adm-045). All employees are required to undergo drug testing prior to employment and will be subject to post-accident, reasonable suspicion, return to duty and follow up drug and alcohol testing in compliance with Federal and State regulations for alcohol and controlled substance testing. Employees in positions holding responsibility for the safety and welfare of others will also be classified as safety sensitive. El Rio Health is a non-profit 501(c)(3) Federally Qualified Health Center (FQHC) and abides by all applicable federal Drug-Free Workplace standards. El Rio Health is an equal opportunity employer.
