We are offering a long-term contract employment opportunity for a Medical Staff Credentialing Coordinator in Sacramento, California, in the medical industry. This role is crucial in processing and managing applications from providers for initial appointment and/or reappointment, as well as other key credentialing processes.
Overview
The Medical Staff Coordinator is responsible for managing the credentialing and privileging process for medical staff and advanced practice providers (APPs). This includes processing initial applications, reappointments, status changes, and privilege requests, ensuring compliance with regulatory standards, Medical Staff Bylaws, and hospital policies. The role also involves coordinating professional practice evaluations (FPPE/OPPE), supporting medical staff committees, and maintaining accurate provider records.
Key Responsibilities
- Oversee the credentialing and privileging process for medical staff and APPs, ensuring all providers meet qualifications based on training, licensure, and experience.
- Review applications for completeness, verify credentials, and confirm that privilege requests align with established criteria.
- Facilitate the biannual reappointment process in compliance with Medical Staff Bylaws and regulations.
- Process requests for additional privileges, deletions, and status changes through appropriate channels.
- Conduct credentialing verifications via written, telephone, and online methods.
- Maintain and update provider information in the credentialing database, generating reports as needed.
- Provide administrative support for Medical Staff Committees, including the Credentials Committee and Ethics Committee, assisting leadership with reports and documentation.
- Prepare and distribute meeting materials, reports, and follow-ups for weekly and monthly credentialing meetings.
- Monitor and flag Category II credentialing issues, ensuring smooth file routing and approval.
- Assist with regulatory audits and health plan credentialing reviews, conducting file reviews and preparing electronic records.
- Track and send reappointment notices, ensuring timely application processing and follow-up with non-compliant providers.
- Manage the initial application process, verifying new practitioners, entering data, and determining privilege requirements.
- Oversee the Focused Professional Practice Evaluation (FPPE) process, ensuring timely follow-ups and report preparation.
- Track credentialing workloads within the Medical Staff Coordinators' team, adjusting assignments as needed.
- Handle dues and fees processing, ensuring timely payments and account reconciliation.
Qualifications
Education:
- High school diploma or equivalent required. Associate degree preferred.
Experience:
- Minimum of two years of medical staff credentialing experience required.
- Preferred experience in hospital physician credentialing, but clinic, HMO, or insurance credentialing may be considered.
Skills & Abilities:
- Proficiency in Microsoft Word and Excel.
- MSOW experience required.
- Strong verbal and written communication skills to interact with physicians, APPs, administrators, and external agencies.
- Ability to work independently with minimal supervision.
- Strong organizational and prioritization skills to manage high-volume workloads efficiently.
- Capacity to multi-task and remain productive in a fast-paced environment with frequent interruptions.
Certifications (Preferred):
- CPCS (Certified Provider Credentialing Specialist)
- CPMSM (Certified Professional in Medical Services Management)