Credentialing Coordinator - Integrated Credentialing - Full Time 8 Hour Days (Non-Exempt) (Non-Union)

University of Southern California; Los Angeles (CA); Sur place; USD 41 000 - 65 000; Plein temps

Résumé du poste

Keck Hospital of USC seeks a Credentialing Coordinator to manage initial credentialing and reappointment for practitioners, ensuring files are complete and processed per policies.

You will verify information, maintain records, and coordinate with the Integrated Credentials Committee to meet deadlines and uphold standards.

Qualifications

• High school diploma or equivalent required.
• Bachelor's degree preferred.
• Degree in related field preferred.
• Around 5 years of credentialing experience preferred.
• Experience in medical group credentialing/provider enrollment preferred.
• Hospital or multi-entity credentialing experience preferred.
• Knowledge of Joint Commission, DNV, NCQA standards, Title 22, and CMS regulations preferred.

Responsabilités

• Process initial credentialing and reappointment applications for timely review.
• Verify information and prepare practitioner files for Integrated Credentials Committee.
• Maintain paper/electronic credentialing records and practitioner databases.
• Perform requests for primary source verification of licenses, malpractice, and training.
• Monitor expirations and send reminder notifications.
• Identify potential adverse information and escalate to supervisor.
• Coordinate with departments and clients for site visits and audits.
• Ensure confidentiality and security of credentialing data.

Connaissances

Credentialing management

Regulatory standards knowledge

Documentation and records management

Attention to detail

Auditing

Formation

High school or equivalent

Bachelor's degree

Degree in related field

Description du poste

The Credentialing Coordinator is responsible for assuring that the credentialing of practitioners is conducted in accordance with the Office of Integrated Credentialing/client policies and procedures, entity bylaws/credentialing plan, regulatory agencies, and accrediting bodies. The Credentialing Coordinator performs quality control audits and coordinates the preparation of completed practitioner files, maintains accurate records regarding the processing status of each practitioner, and flags potentially adverse information. The Credentialing Coordinator is responsible for assuring all activities are conducted as scheduled and per departmental standards. Departmental Specific Summary Essential Duties Processes initial credentialing and reappointment applications, reviews for completeness, verifies information through appropriate resources, and processes the applications to Integrated Credentials Committee, as applicable, in a timely manner and as defined in Credentialing Policies and the Medical Staff Bylaws/relevant Credentialing Plan. Review all returned application materials for appropriateness and completeness, insure that documentation of all training and experience for requested privileges is provided and maintain an on-going dialogue with the applicant and other interested parties to assure that applicants are credentialed by their start/reappointment date. Follow up with client Medical Staff Offices, Departments, clients, practitioners and other respondents regarding incomplete/missing information on documents received according to OIC procedures. Maintains paper/electronic credentials files, clinical privilege forms (as assigned) and practitioner databases to insure information contained is accurate and current. Effectively utilizes all software systems to perform essential job functions, adhering to established data entry conventions. Perform electronic, written and telephonic queries to agencies providing primary source information regarding malpractice claims, licenses, certifications, training and affiliations. Assess content of responses to determine any follow up required. Processes reappointment/credentialing applications including gathering OPPE and other quality data, verification of all required elements in accordance with Credentialing Policies and Medical Staff Bylaws, Rules and Regulations, and relevant Credentialing Plan and submitting to appropriate Department Chairs/Chief/designees and committees for review. Monitor receipt of credentialing information and insure that second and third requests are sent within the defined time frame. Review all application documents and responses for appropriateness and completeness, insure that documentation of all training and experience for requested privileges is provided Evaluate the completeness and integrity of initial applicant, reappointment applicant, and annual evaluation files, and determine when all necessary verificatons and required documents have been completed and are present for appropriate chair/chief/designee and committee review. Work closely with the supervisor in identification of reappointment names and dates Independently make decisions regarding whether information meets OIC, TJC, NCQA, DNV, Title 22, and CMS and relevant bylaws/Credentialing Plan requirements related to content, completeness and timeliness. Ensures maximum confidentiality, accuracy, security, and appropriate access of all data and records, and provides maximum protection from discoverability of all information. Responsible for obtaining approval signatures on applications and delineation of privileges forms prior to presentation at relevant Integrated Credentials Committee, as applicable Prepare completed, accurate practitioner credentials files for delivery to clients. Participates in facility/credentialing preparation for site visits and licensing/accreditation surveys Participate in preparation for and support of internal and external audits of OIC processed files Inform the supervisor of quality and practitioner credentialing issues of concern on a regular and timely basis. Flags potentially adverse information through analysis of application and verifications for competency/care concerns and brings forward to supervisor’s attention. EXPIRABLES MANAGEMENT, as required. Responsible for managing the expiring documents process prior to updating the provider database. Verifies current license, malpractice insurance, DEA, board certification, and other applicable certifications, as required. Contact practitioner prior to expiration of doucments, notified department coordinator/administrator and/or facilities of pending expiriations Process includes accurate data entry and image scanning. Sends notifications of provider expired credentials to OIC supervisor, medical staff clients, hospital departments, provider’s department coordinatore, provider’s chair/chief ONGOING MONITORING, as required Reviews all applicable State Licensing Board Reports (all boards for which we have credentialed providers) monthly to determine whether any unfavorable actions were taken, including but not limited to Medical Board of CA, Osteopathic Medical Board, Dental Board of CA, Board of Registered Nursing, Board of Pharmacy, Clinical Psychology, Physical Therapy Board, Occupational Therapy Board, etc. Notifies supervisor of any Red Flag reports identified. Prints hard copies of Red Flag Information. Maintains electronic and/or paper copies of State Licensing Board Reports each month for future review and reference. Reviews OIG, EPLS and Palmetto reports on a monthly basis and maintains copies of the reports for future review and reference. Notifies supervisor of any Red Flag reports. INITIAL APPLICATION AND REAPPOINTMENT APPLICATION DISSEMINATION, as required Processes requests for initial applications from clinical departments. Sends out reappointment application packets 6 months in advance of reappointment date. OTHER, as required Answer all incoming calls in a timely manner, provides courteous and professional phone support Office Maintenance - Orders and maintains office supplies; coordinates care and maintenance of departmental space and equipment. Stores old files, scans, and destroys confidential documents according to departmental policies. Provides and maintains a file system that allows for easy retrieval of information. Works collaboratively in dissemination of provider data across the enterprise and externally as needed, including, but not limited to: IT, Quality & Outcomes, Compliance, Pharmacy, Call Center, HIM etc. Meeting Scheduling - Coordinates meeting dates and times with all participants. Arranges for conference rooms or other meeting locations, audio-visual equipment, or catering services as needed. Completion of User Provisioning forms that are forwarded to IT for USC Care approved initial applicants, as applicable. Attends and participates in new practitioner/resident orientation events with OIC supervisor, as requested. Performs other duties as assigned.

Qualifications

• Req High school or equivalent
• Pref Bachelor's degree
• Degree in related field
• Pref 5 years
• Five years’ experience as a credentialing professional preferred
• Pref Experience in medical group credentialing/provider enrollment.
• Pref Hospital or multi-entity credentialing experience.
• Req Knowledge of Joint Commission, DNV, AAHC, and NCQA standards, Title 22, and CMS regulations pertaining to the organized medical staff, preferred
• Req Knowledge of medical staff principles, practices, quality assessment, performance improvement functions, and legal concepts related to the organized medical staff, preferred
• Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date.
• (Required within LA City only)
• Pref Certified Professional in Medical Services Management (NAMSS) Valid CPMSM or CPCS certification by the National Association of Medical Staff Services strongly preferred

Keck Hospital of USC, a 343-bed acute care hospital, provides exceptional and innovative care for complex medical and surgical conditions across a wide range of specialties.

The hourly rate range for this position is $30.16 - $47.01.

When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.

USC is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, or any other characteristic protected by law or USC policy. USC observes affirmative action obligations consistent with state and federal law. USC will consider for employment all qualified applicants with criminal records in a manner consistent with applicable laws and regulations, including the Los Angeles County Fair Chance Ordinance for employers and the Fair Chance Initiative for Hiring Ordinance, and with due consideration for patient and student safety.

Please refer to the Background Screening Policy Appendix D for specific employment screen implications for the position for which you are applying. We provide reasonable accommodations to applicants and employees with disabilities. Applicants with questions about access or requiring a reasonable accommodation for any part of the application or hiring process should contact USC Human Resources by phone at [phone], or by email at [e-mail]. Inquiries will be treated as confidential to the extent permitted by law.

Notice of Non-discrimination Employment Equity Read USC’s Clery Act Annual Security Report USC is a smoke-free environment Digital Accessibility

Keck Medicine of USC is the University of Southern California’s medical enterprise, one of only two university-based medical systems in the Los Angeles area. Keck Medicine combines academic excellence, world-class research and state-of-the-art facilities to provide highly specialized care for some of the most acute patients in the country. Our internationally renowned physicians and scientists provide world-class patient care at Keck Hospital of USC, USC Norris Cancer Hospital, USC Verdugo Hills Hospital, USC Arcadia Hospital and more than 100 unique clinics in Los Angeles, Orange, Kern, Tulare and Ventura counties. Keck Medical Center of USC, which includes Keck Hospital and USC Norris Cancer Hospital, is among the top 50 hospitals in the country in 8 specialties, as well as the top three hospitals in metro Los Angeles and top 10 hospitals in California, according to U.S. News & World Report’s 2024-25 Best Hospitals rankings.