The Coordinator is responsible for all aspects of the credentialing, recredentialing, and privileging process for all medical staff and allied health professional staff (health care providers) who provide patient care at facilities associated with Summit Healthcare Association. This includes ensuring health care providers are credentialed, appointed, and recredentialed with health plans. The Coordinator maintains up-to-date data for each health care provider in credentialing database(s) and online systems. The Coordinator serves as an essential link and resource between senior management and medical staff to coordinate the operational processes and ongoing credentialing, privileging, and medical staff governance functions of the associated facilities of Summit Healthcare Association. Responsible for review, analysis and follow up of credentialing and privileging applications, maintaining strict confidentiality, and ensuring compliance with organizational policies and accrediting and regulatory agencies.
Essential Functions / Major Responsibilities:
Manages, coordinates, and monitors all aspects of the initial, provisional, reappointment, and privileging process and health plan credentialing for health care providers to ensure accurate and timely credentialing in compliance with the Medical Staff’s Bylaws and associated policies, health plan policies, and regulatory agency requirements, and in conformity with the Medical Staff Services Office policies and procedures.
Identifies issues that require additional investigation and/or follow-up.
Successfully implements the entire enrollment and health plan credentialing and recredentialing process for the organization (practitioners and entities). Coordinator must maintain timelines on enrollment/credentialing schedules, communicate with practitioners and other departments to update information as needed, clarify carrier information requirements, and maintain and update health plan rosters as requested, maintaining a strict level of confidentiality for all matters pertaining to health care provider credentials.
Process other credentialing requests, as assigned, in accordance with established policies and procedures.
Monitor and maintain health care provider and health plan credentialing expirables.
Prepares summary reports of credentialing/privileging recommendations and ensures flow of information and action items for medical staff committees.
Coordinates credentialing end-of-committee processes to ensure notification of health care providers, departments, and databases.
Assists in coordination, tracking and monitoring of the OPPE and FPPE process ensuring compliance with regulatory standards and Medical Staff policies.
Updates and distributes rosters and provider contact lists.
Maintains confidential credentials files and electronic medical staff database.
Responds to correspondence both internally and externally.
Interprets and explains federal, state, local, and government/insurance agency regulations and guidelines, as well as Medical Staff Bylaws, rules and regulations, policies and procedures.
Advises health care providers, management, and administrators on compliance issues as appropriate.
Ensures compliance with State and Federal requirements and Accreditation standards.
Generates queries and reports from provider database.
Updates all PLIID (Practitioner, Location, Insurance ID) entries (i.e. practitioner and PTAN numbers) once health care provider enrollment process is completed.
Establish professional relationship with health plan contacts to ensure information is being updated correctly and in a timely manner.
Schedules, coordinates, prepares agendas, takes minutes, and provides follow up for medical staff committees as outlined in the Medical Staff Bylaws and associated documents.
Assist in on-boarding and/or orientation of new health care providers according to established policies and procedures.
Education and/or Experience:
High School diploma or equivalent (required).
Basic computer skills (required).
Two years medical staff credentialing experience (required).
NCQA knowledge (required).
Two years health plan credentialing experience (preferred).
CPCS and/or CPMSM (preferred).
Additional Salary Information: Full Time, Excellent Benefits offered!
Internal Number: 2
About Summit Healthcare
Summit Healthcare is a private, not-for-profit organization that has provided medical services to White Mountain residents and visitors. As a regional medical center with 101 licensed beds , we respond to the healthcare needs of more that 90,000 permanent residents and seasonal visitors living in a 3,000 square mile area. Summit Healthcare's goal is to provide patients with state-of-the-art healthcare close to home. Every year we take critical steps to ensure we are meeting this goal by investing in state-of-the-art equipment and technology and by attracting outstanding physicians representing a variety of medical specialties. Summit Healthcare is located in the beautiful white mountains of Northeastern Arizona. The White Mountain area is a friendly, rural community with affordable housing, excellent schools and year round outdoor activities. It is the perfect place to fish, hike, ride horseback, mountain bike, ski, golf, hunt and have countless other sports and outdoor adventures! To learn more about Show Low, AZ and Summit Healthcare Regional Medical Center refer to these websites:
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