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We enjoy what we do every day because we’re part of a team that collaborates and innovates to deliver the best clinical outcomes and patient experiences at hospitals, surgery centers, and medical offices. We share ideas to make healthcare better. We have true work-life balance because we care for our caregivers, too. Join our talented team! Love what you do!

The Credentialing Coordinator is responsible for overseeing the facility credentialing process and payor enrollment for healthcare providers working in the hospital, ensuring compliance with regulatory standards, organizational By-Laws and policies, procedures, and protocols. This role involves managing facility credentialing and payor enrollment processes, including maintaining accurate and up-to-date provider credentialing and enrollment records, and facilitating communication between internal departments, vendors, and external agencies.

This role requires onsite presence throughout the hospital network as well as remote work.

Responsibilities of the Credentialing Coordinator:

Credentialing Process Coordination

• Oversee the credentialing process for healthcare providers, including physicians, CRNAs, and allied health professionals.
• Develop, implement, maintain and enforce credentialing policies and procedures in compliance with facility By-Laws, department policies, accreditation standards and regulatory requirements.
• Coordinate with the individual clinicians, MLBH medical staff office, and other departments to ensure timely completion of credentialing and recredentialing applications.
• Coordinate with the individual clinicians, billing company, and other Somnia departments to ensure timely completion of enrollment and reenrollment applications.

Provider Credentialing

• Manage and coordinate the initial credentialing, privileging, and enrollment process for new providers, including verification of credentials, licensure, DEA certificates, education, training, and professional references.
• Ensure all credential files are accurately maintained and updated according to established protocols.
• Monitor expiration dates for credentials and licensures and initiate the recredentialing process as required.
  
  

Quality Assurance and Compliance

• Conduct quarterly audits of credentialing files to ensure accuracy, completeness, and compliance with regulatory standards and organizational policies.
• Implement quality assurance measures to identify areas for improvement in the credentialing process and address any deficiencies.

Communication and Collaboration

• Serve as a liaison between clinicians and Somnia credentialing department, MLBH credentialing Department, medical staff office, clinicians, local Somnia and MLBH administration; as well as external agencies such as insurance providers and regulatory bodies.
• Communicate credentialing requirements and updates to internal stakeholders and provide guidance on credentialing-related matters.

Data Management and Reporting

• Learn and enhance fluencies, capabilities, and expertise on applicable software systems specific to provider credentialing and payor enrollment.
• Maintain accurate and up-to-date provider credentialing data in the credentialing database or software system; or if said systems are not in place, Excel spreadsheets.
• Generate pipeline reports (e.g.; 30, 60, 90, 120+) and analyze data related to credentialing activities, provider status, and compliance metrics for management review.

Qualifications for the Credentialing Coordinator:

• Certified Provider Credentialing Specialist (CPCS) preferred.
• Minimum of 3 years of experience in healthcare credentialing.
• In-depth knowledge of credentialing standards and regulations
• Excellent communication and interpersonal skills, with the ability to interact effectively with diverse stakeholders.