UHC - Medical Staff Coordinator

United Hospital Center; Bridgeport (WV); On-site; USD 52,000 - 76,000; Full time

Job summary

United Hospital Center in Bridgeport, WV seeks a Credentialing Coordinator to manage credentialing and privileging for physicians and allied professionals, ensuring timely processes and compliance with Joint Commission, NCQA, and CMS standards.

Qualifications include a relevant bachelor’s or associate degree with admin experience, and CPCS/CPMSM certifications (or within 12 months). Strong organizational and computer skills are essential in this fast-paced hospital setting.

Qualifications

• Bachelor’s degree in business or health-related field with 1 year of admin experience.
• Associate Degree in business or health-related field with 3 years of admin experience.
• High School Diploma with 5 years of admin experience.
• CPCS or CPMSM certification (or obtain within 12 months of hire).

Responsibilities

• Coordinate credentialing, recredentialing and privileging for medical staff in line with Joint Commission and NCQA standards.
• Maintain knowledge of Joint Commission, NCQA, state medical boards and CMS standards.
• Monitor and update credentialing processes and forms to ensure compliance with standards.
• Perform primary source verifications of practitioner information.
• Enter and maintain practitioner data in electronic credentialing software accurately.
• Stay current with Medical Staff Bylaws and Credentialing policies.
• Participate in surveys related to credentialing and privileging.
• Serve as WVUH liaison to Managed Care Organizations for delegated credentialing.
• Collaborate with IT and credentialing software vendor for system updates and training.
• Participate in projects identified by Medical Staff Affairs leadership.

Skills

Organizational skills

Office software (Windows, Excel, etc.)

Attention to detail

Professional communication

Ability to work in fast-paced setting

Education

Bachelor’s degree in business or health-related field

Associate Degree in business or health-related field

High School Diploma or equivalent

CPCS or CPMSM certification (or within 12 months of hire)

Job description

Coordinates and administers day-to-day support of the credentialing and privileging process for West Virginia University Hospitals and West Virginia United Health Systems. The process includes, but is not limited to, new applications, provisional reviews, and biennial reappointments for members of the Medical Staff, Licensed Independent Practitioners and Advanced Practice Professionals as defined by the Hospital’s Medical Staff Bylaws.

Minimum Qualifications

EDUCATION, EXPERIENCE, CERTIFICATION, AND/OR LICENSURE

• Bachelor’s degree in business or a health-related field AND one (1) year of experience in an administrative setting.
• Associate Degree in business or a health-related field AND three (3) years of experience in an administrative setting.
• High School Diploma or equivalent AND five (5) years of experience in an administrative setting.

Preferred Qualifications

EDUCATION, CERTIFICATION, AND/OR LICENSURE

• Bachelor’s Degree in business or a health-related field.
• Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Service Management (CPMSM) OR obtained within twelve (12) months of hire.

Experience

• Three (3) years’ experience in a medical staff credentialing role, preferably as a Medical Staff Coordinator or equivalent.
• Experience in a hospital or medical facility.

CORE DUTIES AND RESPONSIBILITIES:

• Coordinates the timely credentialing, recredentialing and privileging of new and current Physicians, Dentists, Licensed Independent Practitioners and Advanced Practice Professionals following Joint Commission and National Committee for Quality Assurance (NCQA) standards.
• Maintain working knowledge of Joint Commission, NCQA, State Medical Boards and Centers for Medicare & Medicaid Services (CMS) standards.
• Monitors and updates the credentialing process, including applications for appointment, reappointment, clinical privilege forms and policies to ensure compliance with Joint Commission, NCQA and CMS standards.
• Performs Primary Source Verifications of practitioner information in compliance with Joint Commission, NCQA and CMS standards.
• Enters, maintains and updates practitioner information into the electronic credentialing software in an accurate and timely manner.
• Maintains a current knowledge of the Medical Staff Bylaws, Rules & Regulations and Credentialing policies.
• Participates in Joint Commission, Office of Health Facility Licensure & Certification (OHFLAC) and Managed Care Organization (MCO) surveys as it relates to the credentialing and privileging of Physicians, Dentists, Licensed Independent Practitioners and Advanced Practice Professionals.
• Serves as the WVUH liaison to Managed Care Organizations in regard to performing delegated credentialing functions in accordance with contractual agreements.
• Work with Information Technology and the electronic credentialing software vendor to maintain a current system through updates and training.
• Participates in project work identified by the leadership of Medical Staff Affairs.

PHYSICAL REQUIREMENTS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

WORKING ENVIRONMENT:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Standard office environment

Skills & Abilities

• Ability to function in a demanding and fast-paced environment.
• Proficient computer skills including, but not limited to thorough knowledge and understanding of office software programs including Windows, Excel, Outlook, or similar applications.
• Possess excellent organizational and prioritization skills.
• Possess professional communication skills.
• Must be detail oriented and possess excellent spelling and grammar skills.

Additional Job Description

Scheduled Weekly Hours: 40

Exempt/Non-Exempt

Shift: United States of America (Non-Exempt)

Company: UHC United Hospital Center

Cost Center: 404 UHC Medical Staff Affairs

Address: 327 Medical Park Drive
Bridgeport
West Virginia

Equal Opportunity Employer

West Virginia University Health System and its subsidiaries (collectively "WVUHS") is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. WVUHS strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. All WVUHS employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.