Credentialing Coordinator- RHC Medical Staff

Job Description

Description

Become part of an inclusive organization with over 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.

Job Summary: 

Performs credentialing for Allied Health Staff & Physicians. Organize, gather all information needed for packet submission to ensure completeness. Monitor licensure, liability insurance, DEA. Gather data for reappointment profiles; peer review information, any NPDB reports. Ensure current list of credentialed physicians/AHPs is updated. Edit and update delineation forms every 2 years. Report to AMA licensure issues. Ensure accreditation and regulatory compliance. Handle all issues that surface regarding physicians, investigate, gather all information needed, inform appropriate persons to discuss. Respond to all verifications/inquiries from outside facilities regarding our medical staff. Peer review information/negative/positive comments updated and kept in folders. Complete applications/reappointments after final approval from Board (stamping, checking procedures approved, and dates of appts./reappointments). Temporary and Full Privileges letters emailed to applicants. Enter into EMR all dates of approval for reappointments and appointments. Work with Scheduler in verifying physicians are credentialed for certain procedures

This role is Hybrid

  Description of Job Responsibilities: 

1. Ensures that all initial and reappointment practitioner applications are processed in accordance with state and federal credentialing regulations including the Joint Commission, CMS, the National Committee for Quality Assurance (NCQA), and the TPN Medical Staff Bylaws. 

2. Demonstrates the ability to organize and prioritize work in order to meet deadlines for appointment and reappointment to the TPN Medical Staff. 

3. Acts as a liaison between participating practitioners, UNCHCS, Rex , Medicare, Medicaid, managed care companies, and insurance groups. 

4. Serves as a resource for the TPN credentialing software system; provides accurate and timely data entry, establishes alerts for reappointments, and maintains compliance with established appointment and reappointment schedules. Monitors and trends data to ensure quality indicators are being met. 

5. Maintains current knowledge of governmental and regulatory guidelines, and adheres to established credentialing policies and procedures. 

6. Provides support to team members to ensure timely insurance enrollment, as well as other administrative duties as needed.

7. Demonstrates effective customer service, communication, and teamwork skills.  

Education Requirements:

 High School degree required 

 Licensure/Certification Requirements:

 Professional Experience Requirements: Requires five years related experience 

Knowledge, Skills, and Abilities Requirements:

Other Information

Job Details

Legal Employer: NCHEALTH

Entity: UNC Rockingham Health Care

Organization Unit: RHC Medical Staff

Work Type: Full Time

Standard Hours Per Week: 40.00

Work Schedule: Day Job

Location of Job: US:NC:Eden

Exempt From Overtime: Exempt: No

This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Heath Care System. This is not a State employed position.

Qualified applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email [email protected] if you need a reasonable accommodation to search and/or to apply for a career opportunity.