The Insurance Credentialing Coordinator is responsible for overseeing and maintaining the credentialing process and works under minimal director from VP Revenue for collecting and verifying data that serves as the basis for credentialing the Medical Staff or Allied Health staff with the appropriate insurance companies including any Third Party.   Responsible for gathering and providing all information regarding the applicant’s licensure, including NPI, Tax-Id and ability to perform privileges requested.

Work Schedule

Monday through Friday, 40 hours/week, or as work needs demand.

Qualifications/Specifications

• Education: High School Diploma required, College Degree preferred.
• Licensure/Certification: None required.
• Experience: Minimum of two years’ experience in medical office scheduling and/or medical administration/record-keeping required. Medical Staff processes and credentialing experience preferred.

Primary Duties

• Plans, organizes and directs a comprehensive centralized insurance credentialing process for the medical staff and allied health professionals. The process is revised as necessary to meet requirements of regulatory agencies and payors.
• Obtains and/or supervises collection, verification and processing of data for initial insurance credentialing.   Ensures the renewal process is handled in a timely manner with no interruption in with billing and collection for services provided.
• Maintains confidentiality of all information and departmental/hospital business activities.
• Maintains accurate, timely and complete information and files for each Medical Staff and Allied Health Practitioner.
• Creates and maintains an accurate calendar for reappointment of practitioners to prevent delays in insurance processing
• Communicates in a timely manner the need for the Medical Staff and Allied Health Practitioner to provide the appropriate information for renewal of insurance credentialing when appropriate.
• Maintains effective communication and relations with practitioners, employees, other departments, administration, the governing body and the public/community.
• May attend, document via minutes and prepare agendas for the minutes of the following meetings as applicable: Governing Body, Medical Executive, Credentials, Bylaws, Surgery Department, Medicine Department, other Medical Staff department/section meetings, ad hoc Medical Staff meetings, disciplinary action Medical Staff meetings, the annual Medical Staff meeting and other meetings requiring Medical Staff involvement.
• Develops and provides new Medical Staff and Allied Health professionals with an orientation program related to the Insurance Credentialing process.
• Serves as the organization’s keeper of the Insurance Credentialing related documents for the Medical Staff and Allied Health Practitioner.  as a process in place to permanently track and log all changes in these documents.
• Responsible for evaluating insurance credentialing and maintaining quality standards with their process to ensure positive processing outcomes as applicable.
• Participates in all hospital-wide and job-specific safety training programs, as well as any additional training based on needs assessment. Shows sufficient and ongoing knowledge of hospital-wide safety practices and those that directly relate to his or her responsibilities.
• Submits Insurance Credentials for contracted personnel as AHPs as applicable.