Credentialing Coordinator - Office Of Integrated Credentialing - Full Time 8 Hour Days Non-Exempt Non-Union

The Credentialing Coordinator is responsible for assuring that the credentialing of practitioners is conducted in accordance with the Office of Integrated Credentialing/client policies and procedures entity bylaws/credentialing plan regulatory agencies and accrediting bodies. The Credentialing Coordinator performs quality control audits and coordinates the preparation of completed practitioner files maintains accurate records regarding the processing status of each practitioner and flags potentially adverse information. The Credentialing Coordinator is responsible for assuring all activities are conducted as scheduled and per departmental standards.

Essential Duties:

• Processes initial credentialing and reappointment applications reviews for completeness verifies information through appropriate resources and processes the applications to Integrated Credentials Committee as applicable in a timely manner and as defined in Credentialing Policies and the Medical Staff Bylaws/relevant Credentialing Plan.
• Review all returned application materials for appropriateness and completeness insure that documentation of all training and experience for requested privileges is provided and maintain an ongoing dialogue with the applicant and other interested parties to assure that applicants are credentialed by their start/reappointment date.
• Follow up with client Medical Staff Offices Departments clients practitioners and other respondents regarding incomplete/missing information on documents received according to OIC procedures.
• Maintains paper/electronic credentials files clinical privilege forms (as assigned) and practitioner databases to insure information contained is accurate and current. Effectively utilizes all software systems to perform essential job functions adhering to established data entry conventions.
• Perform electronic written and telephonic queries to agencies providing primary source information regarding malpractice claims licenses certifications training and affiliations. Assess content of responses to determine any follow up required.
• Processes reappointment/credentialing applications including gathering OPPE and other quality data verification of all required elements in accordance with Credentialing Policies and Medical Staff Bylaws Rules and Regulations and relevant Credentialing Plan and submitting to appropriate Department Chairs/Chief/designees and committees for review.
• Monitor receipt of credentialing information and insure that second and third requests are sent within the defined time frame.
• Review all application documents and responses for appropriateness and completeness insure that documentation of all training and experience for requested privileges is provided
• Evaluate the completeness and integrity of initial applicant reappointment applicant and annual evaluation files and determine when all necessary verificatons and required documents have been completed and are present for appropriate chair/chief/designee and committee review.
• Work closely with the supervisor in identification of reappointment names and dates
• Independently make decisions regarding whether information meets OIC TJC NCQA DNV Title 22 and CMS and relevant bylaws/Credentialing Plan requirements related to content completeness and timeliness.
• Ensures maximum confidentiality accuracy security and appropriate access of all data and records and provides maximum protection from discoverability of all information.
• Responsible for obtaining approval signatures on applications and delineation of privileges forms prior to presentation at relevant Integrated Credentials Committee as applicable
• Prepare completed accurate practitioner credentials files for delivery to clients.
• Participates in facility/credentialing preparation for site visits and licensing/accreditation surveys
• Participate in preparation for and support of internal and external audits of OIC processed files
• Inform the supervisor of quality and practitioner credentialing issues of concern on a regular and timely basis. Flags potentially adverse information through analysis of application and verifications for competency/care concerns and brings forward to supervisors attention.
• EXPIRABLES MANAGEMENT as required. Responsible for managing the expiring documents process prior to updating the provider database. Verifies current license malpractice insurance DEA board certification and other applicable certifications as required. Contact practitioner prior to expiration of doucments notified department coordinator/administrator and/or facilities of pending expiriations Process includes accurate data entry and image scanning. Sends notifications of provider expired credentials to OIC supervisor medical staff clients hospital departments providers department coordinatore providers chair/chief
• ONGOING MONITORING as required Reviews all applicable State Licensing Board Reports (all boards for which we have credentialed providers) monthly to determine whether any unfavorable actions were taken including but not limited to Medical Board of CA Osteopathic Medical Board Dental Board of CA Board of Registered Nursing Board of Pharmacy Clinical Psychology Physical Therapy Board Occupational Therapy Board etc. Notifies supervisor of any Red Flag reports identified. Prints hard copies of Red Flag Information. Maintains electronic and/or paper copies of State Licensing Board Reports each month for future review and reference. Reviews OIG EPLS and Palmetto reports on a monthly basis and maintains copies of the reports for future review and reference. Notifies supervisor of any Red Flag reports.
• INITIAL APPLICATION AND REAPPOINTMENT APPLICATION DISSEMINATION as required Processes requests for initial applications from clinical departments. Sends out reappointment application packets 6 months in advance of reappointment date.
• OTHER as required Answer all incoming calls in a timely manner provides courteous and professional phone support Office Maintenance Orders and maintains office supplies; coordinates care and maintenance of departmental space and equipment. Stores old files scans and destroys confidential documents according to departmental policies. Provides and maintains a file system that allows for easy retrieval of information. Works collaboratively in dissemination of provider data across the enterprise and externally as needed including but not limited to: IT Quality & Outcomes Compliance Pharmacy Call Center HIM etc. Meeting Scheduling Coordinates meeting dates and times with all participants. Arranges for conference rooms or other meeting locations audiovisual equipment or catering services as needed.
• Completion of User Provisioning forms that are forwarded to IT for USC Care approved initial applicants as applicable.
• Attends and participates in new practitioner/resident orientation events with OIC supervisor as requested.
• Performs other duties as assigned.

Required Qualifications:

• Req High school or equivalent

• Req Knowledge of Joint Commission DNV AAHC and NCQA standards Title 22 and CMS regulations pertaining to the organized medical staff preferred
• Req Knowledge of medical staff principles practices quality assessment performance improvement functions and legal concepts related to the organized medical staff preferred

Preferred Qualifications:

• Pref Bachelors degree in related field

• Pref 5 years Five years experience as a credentialing professional preferred
• Pref Experience in medical group credentialing/provider enrollment.
• Pref Hospital or multientity credentialing experience.

• Pref Certified Professional in Medical Services Management (NAMSS) Valid CPMSM or CPCS certification by the National Association of Medical Staff Services strongly preferred

Required Licenses/Certifications:

• Req Fire Life Safety Training (LA City) If no card upon hire one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)

USC is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race color religion sex sexual orientation gender identity national origin protected veteran status disability or any other characteristic protected by law or USC policy. USC observes affirmative action obligations consistent with state and federal law. USC will consider for employment all qualified applicants with criminal records in a manner consistent with applicable laws and regulations including the Los Angeles County Fair Chance Ordinance for employers and the Fair Chance Initiative for Hiring Ordinance and with due consideration for patient and student safety. Please refer to theBackground Screening Policy Appendix Dfor specific employment screen implications for the position for which you are applying.

We provide reasonable accommodations to applicants and employees with disabilities. Applicants with questions about access or requiring a reasonable accommodation for any part of the application or hiring process should contact USC Human Resources by phone ator by email at. Inquiries will be treated as confidential to the extent permitted by law.

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