[Hiring] Credentialing Coordinator @University of Southern California

Role Description

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.

• 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.
• Reviews all returned application materials for appropriateness and completeness, ensures that documentation of all training and experience for requested privileges is provided, and maintains an ongoing dialogue with the applicant and other interested parties to assure that applicants are credentialed by their start/reappointment date.
• Follows 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 ensure information contained is accurate and current.
• Effectively utilizes all software systems to perform essential job functions, adhering to established data entry conventions.
• Performs electronic, written, and telephonic queries to agencies providing primary source information regarding malpractice claims, licenses, certifications, training, and affiliations.
• 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.
• Monitors receipt of credentialing information and ensures that second and third requests are sent within the defined time frame.
• Reviews all application documents and responses for appropriateness and completeness, ensures that documentation of all training and experience for requested privileges is provided.
• Evaluates the completeness and integrity of initial applicant, reappointment applicant, and annual evaluation files, and determines when all necessary verifications and required documents have been completed and are present for appropriate chair/chief/designee and committee review.
• Works closely with the supervisor in identification of reappointment names and dates.
• Independently makes 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.
• Prepares completed, accurate practitioner credentials files for delivery to clients.
• Participates in facility/credentialing preparation for site visits and licensing/accreditation surveys.
• Participates in preparation for and support of internal and external audits of OIC processed files.
• Informs 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.
• Manages the expiring documents process prior to updating the provider database, verifies current license, malpractice insurance, DEA, board certification, and other applicable certifications, as required.
• Contacts practitioner prior to expiration of documents, notifies department coordinator/administrator and/or facilities of pending expirations.
• Reviews all applicable State Licensing Board Reports monthly to determine whether any unfavorable actions were taken.
• Notifies supervisor of any Red Flag reports identified.
• Processes requests for initial applications from clinical departments and sends out reappointment application packets 6 months in advance of reappointment date.
• Answers all incoming calls in a timely manner, provides courteous and professional phone support.
• 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.
• Coordinates meeting dates and times with all participants.
• Attends and participates in new practitioner/resident orientation events with OIC supervisor, as requested.
• Performs other duties as assigned.

Qualifications

• High school or equivalent (Required)
• Bachelor's degree in related field (Preferred)
• Five years’ experience as a credentialing professional (Preferred)
• Experience in medical group credentialing/provider enrollment (Preferred)
• Hospital or multi-entity credentialing experience (Preferred)
• Knowledge of Joint Commission, DNV, AAHC, and NCQA standards, Title 22, and CMS regulations pertaining to the organized medical staff (Required)
• Knowledge of medical staff principles, practices, quality assessment, performance improvement functions, and legal concepts related to the organized medical staff (Required)
• 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)
• Certified Professional in Medical Services Management (NAMSS) - Valid CPMSM or CPCS certification by the National Association of Medical Staff Services strongly preferred (Preferred)

Benefits

• The hourly rate range for this position is $30.16 - $47.01.
• 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.
• We provide reasonable accommodations to applicants and employees with disabilities.

Company Description

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 hospital’s world-renowned physicians deliver compassionate, customized, patient-centered care and treat the most acutely ill patients with highly innovative techniques and treatment plans. As a leading academic medical center, hundreds of clinical trials are currently taking place at Keck Hospital and its affiliated research institutions, giving patients access to novel and promising therapies that are generally not available elsewhere.