Credentialing & Privileging Specialist

Grady Memorial Hospital Corporation; Atlanta (GA); On-site; USD 60,000 - 90,000; Full time

Benefits offered by this job

Health & Wellness benefits

Retirement savings plans

Paid time off

Job summary

Grady Health System in Atlanta is seeking a Credentialing Coordinator to manage initial, recredentialing and privileging for physicians and advanced practice providers delivering patient care.

This role requires thorough knowledge of JCAHO/TJC, NCQA and state/federal standards, data gathering, and independent processing within Grady policies. Collaboration with Medical Staff Services and service chiefs is essential.

Qualifications

• Must possess and maintain a working knowledge of The Joint Commission, NCQA and state/federal accrediting agencies requirements/standards regarding credentialing/privileging.
• Three years of credentialing/privileging experience in a hospital or managed care setting and/or Medical Staff Services.
• Two years of database experience.
• OR Three years minimum in progressively responsible positions in a complex business/administrative office setting, which includes working with physicians, advanced practice providers or other professional groups.

Responsibilities

• Communicates completion of the applications to the Medical Staff Services Director and appropriate review by the Service Chiefs.
• Assists with FPPE and OPPE collection.
• Coordinates the credentialing/ privileging process for assigned physicians and advanced practice providers.
• Acts independently to process credentialing/ privileging applications for physicians and advanced practice providers.
• Maintains thorough understanding of TJC, NCQA and state/federal regulatory credentialing/privileging standards.
• Responsible for the quality and integrity of provider files and meets processing quality and productivity standards.
• Performs routine file audits. Serves as a liaison for physicians and advanced practice providers navigating through the health system.
• Adheres to strict confidentiality requirements.
• Analyzes provider applications for completeness, accuracy, consistency, gaps in work history, relevant references, etc.
• Verifies all credentialing/privileging elements, including but not limited to, education, training, board certification, work history, licensure and certifications, case/procedure logs, malpractice coverage, etc through a variety of primary sources as deemed appropriate per TJC standards and other applicable accrediting agencies.
• Identifies/concerns issues and initiates further data collection as needed.
• Initiates appropriate and timely follow-up information from the Medical Staff Services Department or other sources as needed.

Skills

Credentialing

Privileging

Data analysis

Regulatory compliance

Communication

Education

Associate degree

Tools

Database systems

Job description

Grady Health System in Atlanta is seeking a Credentialing Coordinator to manage initial, recredentialing and privileging for physicians and advanced practice providers delivering patient care.

This role requires thorough knowledge of JCAHO/TJC, NCQA and state/federal standards, data gathering, and independent processing within Grady policies. Collaboration with Medical Staff Services and service chiefs is essential.