Summary:
The Credentialing Coordinator serves as the first line of defense in Health Plan Quality through the functions of providing for adequate and qualified Medical Staff. Under supervision of the Credentialing Manager, the Credentialing Coordinator is responsible for the all aspects of the Credentialing process. Duties include ensuring that the health plan and its providers comply with regulatory and accrediting agencies, interpreting standards, and identifying, recommending and implementing changes. This position serves as the liaison between the plan administration and the medical staff on matters such as credentialing. This includes, but is not limited to, verification of education and training; certification and clinical practice submitted by physicians and allied health professionals. The Medical Staff Credentialing Coordinator demonstrates leadership through the role of advisor to the medical staff and administration in understanding and applying the standards that the medical staff must meet. This position is responsible for developing and maintaining all aspects of the credentialing function, including credentialing practitioners, facilities, and ancillary services both for initial appointment and re-appointment. The Medical Staff Credentialing Coordinator guides health plan leadership and medical staff through such functions such as credentials committee meetings. The Medical Staff Credentialing Coordinator is able to advise the medical staff leadership on matters of priority in an expeditious manner and can instruct them in the responsibilities of their positions with respect to credentialing and help bring them up to date on current issues involving regulatory agencies, clinical privileges, and standards of care. The Credentialing Coordinator should demonstrate strong organizational skills and assertiveness in problem solving.
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