Cerdentialing Coordinator

Trinity Health; Livonia (MI); On-site; USD 45,000 - 65,000; Full time

Job summary

Trinity Health is seeking a Credentialing Coordinator to support the credentialing process for RHMs. The role involves assisting with data entry, verifications, and maintaining the physician database in the CVO module, ensuring timely completion of credentialing requirements.

The position emphasizes confidentiality, accuracy, and adherence to NCQA and TJC standards, with collaboration across the credentialing team and management for process improvements.

Qualifications

• Strong communication skills with patients, applicants, and colleagues.
• Analytical and problem-solving abilities to support credentialing decisions.
• Ability to work autonomously with attention to detail and accuracy.
• Experience with data entry and maintaining provider databases.
• Familiarity with NCQA, TJC standards, and credentialing processes.

Responsibilities

• Assists the Manager in identifying and scheduling reappointment candidates.
• Performs file audits and provides feedback on credentialing files.
• Assists in training and orientation of new team members.
• Maintains confidentiality of patient and provider information.
• Communicates with applicants and RHMs to complete credentialing requirements on time.

Skills

Communication skills

Analytical skills

Problem solving

Organizational skills

Attention to detail

Education

Associates degree in health administration or related field

Two years of post-high school education or training

Tools

Database management

Windows-based software

Job description

Employment Type: Full time Shift: Day Shift

Ensures the timely completion of an application for initial and/or recredentialing by assisting the applicant in submitting all documentation necessary to process the application. Performs a variety of credentialing tasks at the direction of CVO management to complete the credentialing process for Trinity Health RHMs. This position is an integral part of the credentialing team and is responsible for following credentialing policies and procedures; maintaining an accurate physician data base; collecting data; and participating in development and implementation of changes to the credentialing processes.

ESSENTIAL FUNCTIONS

• Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions.
• Assists the Manager in the identification and scheduling of reappointment candidates.
• Performs file audits and provides feedback on completed initial and reappointment credentialing files.
• Assists in the training and orientation of new team members.
• Assists in daily data entry to ensure an accurate physician data base.
• Facilitates the integration of new RHMs into the CVO by assisting with data entry and/or data conversion into the physician data base.
• Communicates regularly with applicants and the RHMs to complete all requirements of the credentialing criteria within specified timeframes.
• Contacts various primary sources to gather the required verifications to complete the background investigation via telephone, fax transmissions, mailings and Internet to ensure rapid completion of the application.
• Prepares documentation of all verifications including a summary of all verified references for each completed credentials file.
• Assists in the reappointment process; collecting required information, verifying information, and completing appropriate follow-up to complete the reappointment application.
• Meets processing time thresholds consistently and with minimal error.
• Assists with the initial drafting of RHM privilege forms in the PCCB module of the credentialing data base.
• Maintains the confidentiality of information acquired pertaining to patient, physicians, employees, and external entities.
• Maintains a customer-focus attitude, good rapport, and cooperative relationships. Approaches conflict in a constructive manner. Helps to identify problems, offer solutions, and participate in their resolution. Tracks errors and complaints to assist with process improvement activities.
• Participates in professional development programs and professional organizations to grow in understanding of the various regulations and legislation of the health care industry as appropriate.
• Maintains good rapport and cooperative relationships. Approaches conflict in a constructive manner. Helps to identify problems, offer solutions, and participate in their resolution.
• Maintains the confidentiality of information acquired pertaining to patient, physicians, employees, and visitors to Trinity Health. Discusses patient and hospital information only among appropriate personnel in appropriately private places.
• Assumes responsibility for performance of job duties in the safest possible manner, to ensure personal safety and that of coworkers, and to report all preventable hazards and unsafe practices immediately to management.
• Performs other duties as needed and assigned by the Director.
• Maintains a working knowledge of applicable Federal, State and local laws/regulations; the Trinity Health Integrity and Compliance Program and Code of Conduct; as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior.

MINIMUM QUALIFICATIONS

• Must possess two years of post-high school education, training, or experience. Associates degree in health administration or a related field preferred.
• One year of work experience in the health care environment and general knowledge of the health care industry including hospital settings, physician practices, and managed care organizations.
• Knowledge and understanding of NCQA and TJC standards, NPDB guidelines, hospital policies and procedures, and general licensing regulations.
• Knowledge and experience with database organization and management, report generating languages, PC's and proficiency in Windows-based word processing software.
• Current CPCS and/or CPMSM eligibility by the National Association Medical Staff Services preferred but not required.
• Strong communication skills including the ability to correspond effectively, as well as verbally convey information clearly, listen actively, and consider varying viewpoints when making decisions.
• Strong statistical, analytical and problem-solving skills.
• Ability and desire to provide quality service to others.
• Strong organizational skills and the ability to provide attention to detail and thoroughness.
• Ability to work autonomously and wi