Health System Credentialing Coordinator

Work schedule: Monday-Friday, day shift hours | Work Type: In-person What to expect. Provides administrative services to support the credentialing/privileging process for all Medical Staff clinicians including psychiatrists, physicians, dentists, psychologists, social workers, nurse practitioners and physician assistants. Processes credentialing/re-credentialing materials and membership applications, tracks progress of credentialing reviews by credentialing committees, Medical Executive Committee, and Board of Trustees. Monitors contents of application packets to ensure completeness, researching problems that impact timely credentialing and privileging. Interfaces with clinicians, Program Directors, Affiliate Directors, and Administrators regarding the credentialing status of clinicians. Establishes and maintains database of credentialing categories and expirations of licenses, insurances, board certification, CPR, and the like. Collects data, prepares reports, and provides administrative support for Medical Staff activities and programs. Organizes Orientation for P.A. clinicians. Represents Director in matters regarding The Joint Commission and Disaster Planning as necessary. Specific responsibilities include:

1. Customer Relations * Actively seeks to provide quality services that meet the needs of clinicians, clinical and administration leadership, Sheppard Pratt and Division of Professional Services staff as well as patients, families, and external professional associations

2. Credentialing, Appointment, & Reappointment Processes * Oversees credentialing process for all Medical Staff clinicians, active, courtesy, and consulting staffs. * Maintains current files per The Joint Commission (TJC) and State of Maryland requirements. * Prepares appropriate files for Credentialing Committee, Medical Executive Committee, and Board of Trustees review. * Maintains ECHO database for all clinicians, generating reports, queries, letters, and lists as needed. * Analyzes functionality of ECHO to enhance effectiveness and efficiency of the credentialing process and follows up with internal and external Information Technology resources as appropriate. * Tracks expiring licenses, certifications, and insurances providing notices to clinicians and supervisors at least two months prior to expiration. * Provides updates to Director regarding status of credentialing files for both appointments and reappointments. * Requests Temporary Privileges per policy. * Requests Expedited Privileging per policy. * Compiles State of Maryland updates every six months regarding privileges of physicians.

3. Policies & Procedures * Maintains Department of Psychiatry & Medicine, Psychology, and Master’s Prepared Clinician policies, procedures, and Bylaws. * Follows through to effectuate revisions to policies, procedures, and Bylaws based on the recommendation of the Medical Executive Committees. * Ensures presentation of revisions to Board of Trustees for approval and that signed policies are current and available at all times. * Communicates with Medical Staff regarding Bylaw changes. * Develops and implements credentialing practices and procedures for Director’s approval according to licensing, regulatory, and accreditation requirements.

4. Problem Resolution * Researches and resolves problems related to credentialing and privileging. * Audits files to ensure that all P.A. clinicians have appropriate privileges.

5. Fiscal Administration * Manages and pays clinician and hospital dues for the Departments of Psychiatry & Medicine and Psychology. * Manages payments for service through the National Practitioners database and to obtain primary source verifications and claims histories.

6. P.A. Orientation * Coordinates and schedules programs to effectively orient newly hired P.A. staff to P.A. and Sheppard Pratt, interfacing with new employee, orientation participants, and clinical & administrative supervisors.

7. Managed Care/ Administrative Support * Supports Division goals and objectives by collecting data; preparing reports. * Provides other administrative support as required. * Works closely with Managed Care Coordinators to ensure completeness of clinician files for pre-delegation and annual delegated agreement audits. * Creates and maintains ECHO tracking mechanism for use by Managed Care Coordinators. * Provides documentation and responds to credentialing inquiries during MCO delegated audits. * Works with Director to prepare auditor-recommended policy changes to comply with NCQA and CMS requirements to ensure continuation of delegated MCO agreements. * Coordinates Annual Meeting of the DPM, preparing and disseminating agenda, purchasing gifts, ordering equipment and meals, and preparing comprehensive minutes for approval of Chair, DPM., Job Summary: The Patient Care Coordinator is responsible for overseeing the management and coordination of care for the acute inpatient population. The PCC collaborates with roun… + 6 days ago

The pay range for this position is $24.0814 minimum to $37.1830 USD maximum. Pay for this position is determined on a number of factors, including but not limited to, years and level of related experience. What we need from you. * Work requires knowledge of behavioral health and the credentialing and privileging function, The Joint Commission (TJC) and NCQA requirements, the ability to effectively communicate both orally and in writing, and strong computer skills, including Excel and Word - acquired through high school education and two to three years of administrative work experience. Bachelor’s degree and prior healthcare experience are preferred.

• Work requires interpersonal skills sufficient to communicate effectively with P.A. clinicians, clinical and administrative leadership, professional organizations, members of the insurance community, information technology staff in external organizations, and other internal staff (21%-50% of work time).
• Work requires proven project/program and problem-solving administrative skills using Word, Excel, and ECHO.
• Work requires the ability to prioritize workload, planning for cyclical as well as daily tasks/events meeting deadlines, responding promptly to critical organizational/program issues, and managing the demands of multiple projects very frequently (51%-80% of work time) produces a great deal of mental/visual stress and fatigue.

What you’ll get from us. At Sheppard Pratt, you will work alongside a multi-disciplined team led by a bold vision to change lives. We offer:

• A commitment to professional development, including a comprehensive tuition reimbursement program to support ongoing education and licensure and/or certification preparation
• Comprehensive medical, dental and vision benefits for benefit eligible positions
• 403b retirement match
• Generous paid-time-off for benefit eligible positions
• Complimentary Employee Assistance Program (EAP)
• Generous mileage reimbursement program