Credentialing Coordinator II (Eastern United States resident)

Geisinger; Pennsylvania; Hybrid; USD 60.000 - 75.000; Vollzeit

Benefits dieser Stelle

Healthcare benefits from day one

Equal opportunity employer

Zusammenfassung

Geisinger is seeking a Credentialing Specialist to plan, coordinate, and oversee procedures for provider credentialing and privileging. You will ensure regulatory compliance, conduct background investigations, and manage provider files for appointment and reappointment.

This role emphasizes accuracy, confidentiality, and collaboration with physicians and staff. The position requires a High School Diploma or GED and a minimum of four years of related work experience, with strong communication and

Qualifikationen

• High School Diploma or GED required.
• Minimum of 4 years related work experience.
• Skills include Communication, Computer literacy, Credentialing, Professional presentation, and working independently.

Aufgaben

• Plans, coordinates, and oversees credentialing procedures and processes.
• Reviews primary source verification for licensure, certification, or registration.
• Maintains physician files and confidentiality; prepares files for Credentials Committee.
• Assists with background checks, drug screening, and compliance with regulatory standards.
• Establishes and maintains relationships with physicians, staff, and administrators.

Kenntnisse

Communication

Computer literacy

Credentialing

Professional presentation

Working independently

Ausbildung

High School Diploma or GED

Jobbeschreibung

• Location: Work from home (Pennsylvania)
• Shift: Days (United States of America)
• Scheduled Weekly Hours: 40
• Worker Type: Regular
• Exemption Status: No

Job Summary:

Plans, coordinates, and oversees procedures and processes of the Provider Credentialing Program in compliance with regulatory requirements. Ensures compliance with all credentialing and privileging requirements of applicable regulatory agencies. Conducts background investigations on physicians and other providers applying for affiliation including licensure, education and post-graduate clinical training, board certification, disciplinary actions and other professional sanctions, malpractice history, and peer assessment of current competence at time of appointment, reappointment, and cross credentialing.

Job Duties:

• Preferred experience in Echo or Credential Stream Reviews and analyzes physician applications and credentialing documents including certificates of education, residency and fellowship training, board certification and eligibility, licensure, professional work history, liability insurance and malpractice history.
• Assesses completeness of information and providers' qualifications relative to established standards.
• Reviews and analyzes primary source verification for licensure, certification or registration required to practice a profession.
• Requests, maintains, and ensures competency data is present at appointment and re-appointment.
• Maintains tracking of all new providers drug screening, background checks, child abuse clearance, finger printing, code of conduct, disruptive practitioner policies, current clinical competency data and Health Service information for new providers.
• Maintains a working knowledge of applicable regulatory agencies.
• Immediately reports to manager any collected information which may be averse to an applicant.
• Identifies and flags adverse information from application materials for the purpose of conducting special follow-up investigations in preparation for credentialing review.
• Maintains an understanding of the third-party payor requirements.
• Prepares and screens, mails letter, tracks and responds daily.
• Employs public relations skills in a wide variety of phone contacts with external sources for purposes of soliciting information essential to credentials investigations, including licensing agencies; university and hospital training program administrators; certification boards; liability insurance carriers; hospital officials and credentials staff; and physicians and their office staffs.
• Organizes and maintains physician files and information following confidentiality guidelines, performs varied clerical support functions.
• Internally audits and maintains physician files in accordance with established principles of legal documentation and confidentiality.
• Prepare all files monthly for Credentials Committee review and follow up on Credentials Committee Decisions.
• Establish and maintain excellent relationship and good communication channels with physicians, office staff, and practice administrators.
• Assist with Special projects (i.e., physician education, JCAHO and Department of Health Preparation, clinical competency data, life supports) Maintain a thorough understanding of the standards of JCAHO, Department of Health, Bylaws, Rules and Regulation of the Medical Staff, and other regulatory agencies as appropriate.
• Maintains provider database and manipulates database to extract information for ad hoc reports, surveys, and internal and external provider directory extracts.
• Adapts software as needed to facilitate efficient operation of credentials department and continuous quality improvement.
• Work is typically performed in an office environment.
• Accountable for satisfying all job specific obligations and complying with all organization policies and procedures.

Position Details:

• Education: High School Diploma or Equivalent (GED)- (Required)
• Experience: Minimum of 4 years-Related work experience (Required)
• Certification(s) and License(s):
• Skills: Communication, Computer Literacy, Credentialing, Professional Presentation, Working Independently

OUR PURPOSE & VALUES:

• KINDNESS: We strive to treat everyone as we would hope to be treated ourselves.
• EXCELLENCE: We treasure colleagues who humbly strive for excellence.
• LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow.
• INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation.
• SAFETY: We provide a safe environment for our patients and members and the Geisinger family.

We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners.

Perhaps just as important, we encourage an atmosphere of collaboration, cooperation and collegiality. We know that a diverse workforce with unique experiences and backgrounds makes our team stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to make better health easier for all.

We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.

Geisinger is committed to making better health easier for the more than 1 million people it serves. Founded more than 100 years ago by Abigail Geisinger, the system now includes nine hospital campuses, a 550,000-member health plan, two research centers and the Geisinger Commonwealth School of Medicine. With nearly 24,000 employees and more than 1,600 employed physicians, Geisinger boosts its hometown economies in Pennsylvania by billions of dollars annually.

We offer healthcare benefits for full time and part time positions from day one, including vision, dental and benefits for domestic partners. Perhaps just as important, we encourage an atmosphere of collaboration, cooperation and collegiality. For more information, visit www.geisinger.org, or connect with us on Facebook, Instagram, LinkedIn and Twitter.

* Does not qualify for J-1 waiver. We are an affirmative action, equal opportunity employer. Women and Minorities are Encouraged to Apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status.