Credentialing Coordinator

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Day - 08 Hour (United States of America)

This is a Stanford Health Care job.

A Brief Overview
Responsible for processing applications for appointment and/or reappointment from providers as well as other processes pertinent to credentialing, such as change of status and/or category changes (i.e., resignations), and additional privilege requests. Ensures that appointments and reappointments meet regulatory standards. Interprets the Medical Staff Bylaws, Rules & Regulations, general hospital policies and procedures, and other regulations governing the Medical Staff.

What you will do
  • Reviews applications and other documents for completeness and initiates verification of all information contained therein as well as ensuring that requests for privileges are appropriate based on set criteria.
  • Obtains Service Chief approvals and provides information for the file review and approval process as appropriate.
  • Initiates and/or completes biannual reappointment process of staff members as required in the Medical Staff Bylaws and regulations.
  • Processes requests for addition/deletion of privileges and/or change of staff status through the appropriate services and committees.
  • Obtains credentialing verifications for practitioners on staff from outside sources including written, telephone and on-line searches.
  • Maintains and updates the information for the providers in the electronic database.
  • Provides feedback and support as needed to the Medical Staff Credentials and Interdisciplinary Practice Committees, the Assistant Director, Supervisors, and Director as needed.
  • Provides information concerning credentialed providers to MSSD Leaders in preparation for health plan, State, and regulatory audits.

Education Qualifications
  • High School Diploma or GED equivalent, Associates Degree preferred

Experience Qualifications
  • Two (2) years of medical staff and/or credentialing experience required (experience in physician credentialing in a hospital is preferred; however, experience in a clinic, health maintenance organization (HMO), or insurance company may meet the requirement depending on work performed)

License/Certifications:

One of the following certifications will be required within five (5) years of hire in this position:
  • Certified Provider Credentialing Specialist (CPCS): or
  • Certified Professional in Medical Services Management (CPMSM)

Required Knowledge, Skills and Abilities
  • Ability to type minimum 65 wpm required
  • MSOW experience highly preferred
  • Knowledge of computer applications and word processing required. (Microsoft Word, Excel, and Access preferred)
  • Organizational skills and ability to communicate effectively both orally and in writing are required
  • Ability to interact with all levels of management and able to set priorities and manage multiple demands effectively
  • Ability to function well within a team and independently
  • Ability to efficiently organize, prioritize, and maintain workload via electronic database and use available resources as appropriate

These principles apply to ALL employees:

SHC Commitment to Providing an Exceptional Patient & Family Experience

Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford's patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery.

You will do this by executing against our three experience pillars, from the patient and family's perspective:

  • Know Me: Anticipate my needs and status to deliver effective care
  • Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health
  • Coordinate for Me: Own the complexity of my care through coordination

#LI-RL1

Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.