Credentialing Coordinator (Accountable Care)

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This is a Stanford Health Care job.

A Brief Overview
The Credentialing Coordinator is responsible for leading, coordinating, monitoring and maintaining the credentialing, re-credentialing, and privileging of practitioners in accordance with organizational policies and procedures. He/she performs all assigned activities associated with initial and re-appointments, ensuring interpretation and compliance with the appropriate accrediting and regulatory agencies including verification, peer recommendations, and follow-up on concerns that may delay completion of the credentialing or privileging process.
Responsible for the accuracy and integrity of the credentialing database system and related applications. In addition will track and update databases to reflect current compliance with credentialing and privileging elements.

Locations
Stanford Health Care

What you will do

• Record & maintenance of credentialing and re-credentialing of provider files; prepares credentials files for completion and

• presentation, ensuring file completion within specified timeframes.

• On-going monitoring of credentialing sanctions.

• Assisting preparation of UM/QI credentialing meetings and assists with managed care delegated credentialing audits.

• Work closely with CVO and PSV.

• Coordinating with Medical Offices.

• All other duties as assigned including department-specific functions and responsibilities:

• Performs other duties as assigned and participates in organization projects as assigned.

• Adheres to safety, P4P’s (if applicable), HIPAA and compliance policies.

Education Qualifications

• Two (2) years of college or equivalent work experience, in a managed care environment.

Required Knowledge, Skills and Abilities

• Proficient in Microsoft Office product suite (including Outlook, Excel, Word).

• Excellent verbal and written communication skills, as well as the ability to document thoroughly within the data system.

• Ability to work within established guidelines and protocols.

• Ability to utilize web-based resources for information retrieval purposes.

• Ability to work in close cooperation with all departments.

• Ability to prioritize multiple projects as well as perform other duties for departments within the organization.

• Knowledge of NCQA Guidelines and JACHO to maintain certifications.

• Knowledge of ICE regulations for Healthcare providers.

• Strong working knowledge of new guidelines and regulations

Physical Demands and Work Conditions

Physical Demands

• Constant Sitting.

• Frequent Walking.

• Occasional Standing.

• Occasional Bending.

• Occasional Squatting.

• Occasional Climbing.

• Occasional Kneeling.

• Seldom Crawling.

• Constant Hand Use.

• Constant Repetitive Motion Hand Use.

• Frequent Grasping.

• Occasional Fine Manipulation.

• Frequent Pushing and Pulling.

• Occasional Reaching (above shoulder level).

• Frequent …