Under the direction of the Director of Medical Staff Services, the Credentials Coordinator is responsible for all aspects of credentialing, including initial appointment, reappointment and privileging. The Credentials Coordinator will process applications, verify information, research application details, and assure processes are in accordance with the PCH Medical Staff Bylaws, State and Federal Requirements, and accreditation standards. The Credentials Coordinator will provide consistent, accurate, and timely credentialing support, enhancing the organization’s ability to provide professional services. Work includes the accurate, timely and documented verification of the information provided by the applicant and maintenance of the highly confidential credentialing related files. The Credentials Coordinator assists with delegated credentialing, coordination of audits, and assures quality and timeliness of outcomes ensuring compliance with accreditation standards.
- Family-Centered care that focuses on the need of the child first and values the family as an important member of the care team
- Excellence in clinical care, service and communication
- Collaborative within our institution and with others who share our mission and goals
- Leadership that set the standard for pediatric health care today and innovations of the future
- Accountability to our patients, community and each other for providing the best in the most cost-effective way.
Coordinates accurate verification of provider files for initial appointment and for reappointment within established time frames and in accordance with the standards required by the accrediting/regulatory agencies.
- Determines that provider applicant meets initial criteria.
- Determines application form/attachments are complete prior to processing.
- Oversees creation of applicant file, including electronic and computer-generated verifications.
- Monitors status of verified information.
- Analyzes verifications for content and generates follow-up requests for additional information if necessary and/or requested.
- Advises Director of any adverse or questionable information received and recommends follow-up action, which may include review by risk management or legal department.
- Promotes and maintains confidentiality of provider files and all information related to the credentialing process.
Activates review by the appropriate Section Chief, Department Chair, and Credentials Committee Chair once the verification component is completed and the file is deemed complete.
- Notifies individual and/or committee of files ready for review.
- Under the direction of the Section Chief, Department Chair, and/or Credentials Committee Chair develops a detailed FPPE for all initial applicants to the medical staff and any new privilege requests.
- Meets with individual reviewers, as necessary, and attends Credentials Committee meetings to provide needed information.
- Advises reviewers of applicant’s credentials with questionable or adverse information received and provides guidance to Credentials Committee in their review, analysis, and recommendations for the applicants.
- Reviews all applicable committee minutes to assure action taken is appropriately documented. Advises recording personnel of any corrections to be made.
- Coordinates notification of Board approvals to applicant and appropriate plan parties.
- Provides information/education to personnel within the organization regarding credentialing requirements of regulatory agencies and issues involving outcome of credentialing decisions.
- Maintains demographic information on providers in the database.
Identifies areas for improvement in the credentialing process and recommends options for consideration.
- Evaluates processes as they exist and measures outcome in terms of accuracy and time lines to determine if need for improvement exists.
- Monitors changes in accreditation and regulatory standards through communication with Director and/or other appropriate personnel.
- When requested, outlines key components of a new or existing policy/procedure for update.
Maintains up-to-date knowledge regarding credentialing processes and related accrediting and regulatory standards.
- Networks with colleagues in the profession.
- Reads industry information relative to credentialing.
- Shares knowledge gained with others.
- Processes requests for temporary privileges.
Schedules, attends and supports the Credentials Committee.
- Prepares the meeting agendas in consultation with the committee chair.
- Prepares all meeting packets and materials.
- Records conclusions and recommendations succinctly and accurately to substantiate actions taken.
- Maintains confidentiality discussions and other sensitive matters relating to the credentialing process.
- Coordinates all follow-up documentation and communication.
Responsible for file audits as required by regulatory authorities and third party payers.
- Maintains delegate files in accordance with the standards set forth by internal policies and procedures and external regulatory requirements.
- Performs pre-delegation assessments and annual delegation audits including policy and procedure review and file review to ensure regulatory compliance.
- Engages in development, communication and follow-up for corrective action plans for delegated providers.
- Responsible for periodic reporting to third party payer as outlined in the executed delegated credentialing agreement.
- Performs miscellaneous job related duties as requested.