NETWORK CREDENTIALING COORD
To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values integrity, patient-centered, respect, accountability, and compassion must guide what we do, as individuals and professionals, every day.
Responsible for the administration and coordination of services associated with contracts for credentialing and re-credentialing activities provided by the Department of Physician Services via contract with physician networks or other facilities. These include, but are not limited to, the following: North East Medical Group (NEMG), Shoreline Surgery Center, Shoreline Endoscopy Center and Grimes Health Center. Provides support as assigned or needed for other Departmental credentialing / re-credentialing activities. Responsible for continuous updating and maintenance of the credentialing database relative to fields applicable to the work of this position. Is directly accountable for all duties to the Director or his/her designee.
* 1. Responsible for coordination of all credentialing and re-credentialing activities for assigned physician network.
* 1.1 Responsible for coordination of all credentialing and re-credentialing activities.
* 2. Responsible for all credentialing and re-credentialing activities for assigned facilities. These may include, but are not limited to, the following: Shoreline Surgery Center (SSC), Shoreline Endoscopy Center and Grimes Health Center: Responsible for the administration of delegated credentialing agreements between the Department of Physician Services and the assigned facility/ies.
* 2.1 Responsible for the administration of delegated credentialing agreements between the Department of Physician Services and relevant facilities as assgined.
* 3. Provides support as assigned or needed for other Departmental credentialing / re-credentialing activities. (This may include Guest/Observer appointments)
* 3.1 Responsible for the appointment of Medical Staff Guests & Observers
Position requires a Bachelor's Degree. Previous (2-3 years) experience in credentialing within health plans / payors, hospitals, or other entity involved in credentialing required. Candidates with an Associate's Degree and significant directly relevant experience (5+ years) or Associates Degree, 2-3 years experience and current CPCS or CPMSM certification will also be considered eligible.
Two to three years experience with demonstrated knowledge and understanding of physician credentialing and re-credentialing including understanding of NCQA and/or Joint Commission standards. Knowledge about and experience in the practitioner enrollment process for governmental payors.
Must have demonstrated strong computer skills. Thorough knowledge of Microsoft Excel including ability to manipulate and combine large databases. Use of Microsoft Excel will be part of daily work. Experience with credentialing software system strongly preferred. Must be able to maintain confidentiality with respect to all data. Ability to work with an extraordinary level of accuracy involving extreme levels of detail. Must have outstanding customer service skills and professionalism. Must be able to work to firm deadlines.