Credentialing Coordinator

Summary

Position Summary
The Credentialing Coordinator performs complex credentialing and privileging functions essential to the mission and business of the institution, while managing multiple projects and priorities simultaneously.  

Essential Duties

1. Completes, monitors and maintains all aspects of internal credentialing and privileging for providers through the initial and reappointment processes. Conducts all aspects of credentialing in a manner that maintains the integrity of established processes and compliance with regulatory requirements as outlined in Medical Staff governance documents, hospital policies, Joint Commission standards, NCQA standards, and State and Federal laws.  Maintains a current knowledge of legal issues and regulatory requirements which impact Medical Staff credentialing.
2. Researches, verifies, and analyzes applications and completed credentials files.  Investigates and resolves credentialing or privileging issues by obtaining appropriate follow-up documentation and report all identified issues to the Director of Medical Staff Services.
3. Works as part of the MSS team to assist with external/partner facility credentialing and privileging for National Jewish Health faculty and contracted physicians.  Acts as a liaison between the NJH Medical Staff and our external/partner facilities when necessary.
4. Develops and maintains current, accurate, and confidential credential files for each credentialed/privileged provider. Handles and assures the confidentiality of sensitive information about providers including peer review, performance improvement data, health matters, and medico-legal issues.
5. Assists in maintaining the accuracy and integrity of the credentialing and clinical privileging database system.  Produces verification letters as needed and acts as a resource for internal and external customers regarding practitioner information and data.  Understands how to access and run various reports to extract data from the credentialing software if needed in the absence of the department director.
6. Participates in the enrollment process to enroll providers and the facility to bill Colorado Medicaid.
7. Participates in and contributes to ongoing development, planning and implementation of medical staff services processes to ensure compliance with accrediting and regulatory agencies specific to credentialing. 

Other Duties

1. None

Competencies

1. Accountability: Accepts full responsibility for self and contribution as a team member; displays honesty and truthfulness; confronts problems quickly; displays a strong commitment to organizational success and inspires others to commit to goals; demonstrates a commitment to National Jewish Health. 
2. Adaptability: Maintaining effectiveness when experiencing major changes in work responsibilities or environment; adjusting effectively to work within new work structures, processes, requirements, or cultures.
3. Attention to Detail: Accomplishing tasks by considering all areas involved, no matter how small; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period of time. Setting high standards of performance for self and others; assuming responsibility and accountability for successfully completing assignments or tasks; self-imposing standards of excellence rather than having standards imposed.
4. Collaboration and Teamwork: Cooperates with others to accomplish common goals; works with employees within and across his/her department to achieve shared goals; treats others with dignity and respect and maintains a friendly demeanor; values the contributions of others.
5. Creativity and Innovation: Applies creative problem-solving skills to develop solutions to problems; recognizes and demonstrates the value in taking “smart” risks and learning from mistakes; develops multiple alternatives and understands the feasibility of each; effectively shares and implements his/her ideas. Generates innovative solutions in work situations; tries different and novel ways to deal with work problems and opportunities.
6. Customer Focus: Ensuring that the customer perspective is a driving force behind business decisions and activities; crafting and implementing service practices that meet customers’ and own organization’s needs.
7. Initiative: Taking prompt action to accomplish objectives; taking action to achieve goals beyond what is required; being proactive.
8. Managing Work and Time: Effectively managing one’s time and resources to ensure that work is completed efficiently. Effectively manages project(s) by appropriately focusing attention on the critical few priorities; effectively creates and executes against project timelines based on priorities, resource availability, and other project requirements (i.e., budget); effectively evaluates planned approaches, determines feasibility, and makes adjustments when needed.

Supervisory or Managerial Responsibility
None

Travel
None

Core Values

1. Be available to work as scheduled and report to work on time.
2. Be willing to accept supervision and work well with others.
3. Be well groomed, appropriately for your role and wear ID Badge visibly.
4. Be in compliance with all departmental and institutional policies, the Employee Handbook, Code of Conduct and completes NetLearning by due date annually.
5. Fosters an inclusive workplace where diversity and individual differences are valued and leveraged to achieve the vision and mission of the institution.
6. Adheres to safe working practices and at all times follows all institutional and departmental safety policies and procedures. 
7. Wears appropriate PPE as outlined by the infection control policies and procedures.
8. Demonstrates compliance with all state, federal and all other regulatory agency requirements.

Minimum Qualifications

1. Education: High school diploma or equivalent required.  Bachelor’s Degree preferred.
2. Work Experience: 3 years of recent and related Medical Staff Services or credentialing/privileging experience preferred.  
3. Special Training, Certification or Licensure: CPCS (Certified Provider Credentialing Specialist) certified preferred.  Required within 1 year of eligibility to take the certification exam.  

Salary Range: $24.00 - $29.00

Benefits

At National Jewish Health, we recognize that our outstanding faculty and staff are the essence of our organization. For every aspect of health care, our employees are our greatest asset.

With that in mind, we have designed a valuable, comprehensive benefits package to meet the needs of our employees and their families.

• Medical Plans, Dental Plans and Vision Insurance
• Retirement Plan
• FSA and HSA
• Short and Long Term Disability
• Life Insurance and AD&D
• Voluntary Benefits, like Accident Insurance, Critical Care and Hospital Indemnity
• Sick and Vacation Paid Time Off
• Wellness Program
• Legal Plan