Credentialing Coordinator

Job Summary: The Credentialing Coordinator is responsible for managing all aspects of the credentialing process for medical staff and allied health professionals at the pain management and surgery center. This includes ensuring that all medical staff members meet the required standards and qualifications, maintaining up-to-date records, and ensuring compliance with relevant regulations and accreditation standards. Key Responsibilities: Credentialing and Re-credentialing: Manage the initial credentialing and re-credentialing process for all medical staff and allied health professionals. Responsible for both Facilities and Payor credentialing Verify the credentials, licenses, education, training, and work experience of applicants. Ensure timely completion of credentialing applications and renewals. Assist and provide oversight related to physician licensing, DEA applications and other federal and state required participations. Compliance and Accreditation: Ensure compliance with all federal, state, and local regulations, and accreditation standards. Maintain knowledge of current standards, regulations, and guidelines related to medical staff credentialing. Prepare for and participate in audits and accreditation reviews. Database Management: Be knowledgeable of payor credentialing and able to communicate with payors to add locations and providers Maintain accurate and up-to-date credentialing records in the credentialing database. Manage and update credentialing software and systems. Generate reports and provide data as needed for compliance and performance improvement purposes. Policy and Procedure Development: Develop and update policies and procedures related to the credentialing process. Ensure that all credentialing activities are performed in accordance with established policies and procedures. Communication and Coordination: Serve as a liaison between medical staff, administration, and external organizations regarding credentialing matters. Communicate credentialing requirements and updates to medical staff and other relevant parties. Coordinate with various departments to ensure smooth onboarding of new medical staff. Quality Assurance: Conduct regular audits of credentialing files to ensure accuracy and completeness. Identify and address any discrepancies or issues in the credentialing process. Implement continuous improvement initiatives to enhance the efficiency and effectiveness of the credentialing process. Qualifications: Education: (preferred but not required) Bachelor’s degree in healthcare administration, business administration. Experience: Minimum of 3-5 years of experience in Medical Staff and/or payor, preferably in a pain management and/or surgery center setting. Experience working with Medicare Provider Enrollment, Chain, and Ownership System (PECOS) Knowledge of relevant accreditation standards and regulatory requirements. Skills: Strong organizational and time management skills. Excellent attention to detail and accuracy. Effective communication and interpersonal skills. Ability to work independently and as part of a team. Proficient in Microsoft Office Suite (Word, Excel, PowerPoint) Needs to be organized, thorough, detail oriented and intelligent and can maintain privacy Must be able to communicate effectively with providers. Certifications: Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) preferred. Working Conditions: Office environment within a healthcare facility. Occasional travel may be required for training and conferences. Some evening or weekend work may be necessary to meet deadlines or address urgent credentialing issues. Benefits: Health, dental, and vision insurance Retirement plan Paid time off and holidays Professional development opportunities