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Job Description Summary:

The Credentialing Program Coordinator applies the principles of credentialing following the Joint Commission (TJC) accreditation standards or NCQA accreditation standards to independently analyze and review discrepancies within the initial application and reappointment applications received. This role requires utilization of three sets of Credentialing Policies and Procedures to support TJC accreditation for the OhioHealth hospitals and NCQA accreditation for the OhioHealth Clinically Integrated Network and OhioHealthy Medical Plan. This position supports the goal to improve patient safety and reduce risk through meeting regulatory and accreditation requirements.

The Credentialing Program Coordinator role manages and supports the relationship as a front-line liaison between practitioners (physicians, podiatrists, dentists, psychologists, and allied health practitioners), credentialing contacts, as well as hospital departments (ex, Medical Staff Offices, business unit leaders, etc.) and network contacts (CIN, OhioHealthy, other payers and/or delegated arrangements).

This position also supports the data integrity and functionality of the credentialing database. This database is a system-wide database housed within the credentialing area, which is interfaced with applications throughout the organization to support provider demographics, billing information, etc.

Responsibilities And Duties:

85% Coordination of Initial Applications, Reappointments, and Maintenance of Credentialing Database

The Credentialing Program Coordinator has oversight of the credentialing process for physicians and allied health practitioners. This position independently organizes, coordinates, and facilitates quality credentialing and re-credentialing activities. This position verifies an application (initial or reappointment) is complete for submission and ensures the appropriate secondary addendums/forms are submitted as required. This position validates CAQH (a required Ohio credentialing application) is submitted in a complete fashion prior to any credentialing processes starting. The Credentialing Program Coordinator can independently address any issues that arise related to economic credentialing and may establish network status with governmental payers.

The Credentialing Program Coordinator has a keen eye to detail, ensuring changes are updated daily within the credentialing database to ensure billing and provider accuracy for the data feed to CareConnect. This includes information specific to provider demographics, practice changes, billing information, etc. as well as updates to areas of expertise.

The Credentialing Program Coordinator collaborates with department leadership to help ensure that the daily activities of the Program Coordinator role are performed in an efficient manner, streamlining credentialing processes where possible.

The Credentialing Program Coordinator communicates effectively with professionals at a variety of levels both internally and externally while displaying an excellent customer service attitude. This role shows courtesy, compassion, and respect; conforms to the critical service standards established for the department.

The Credentialing Program Coordinator can work individually and independently with minor supervision while meeting productivity expectations and maintaining high quality work.

15% Other Credentialing Activities

Additional credentialing database management to support data integrity and functionality:

Monitoring/Updating/Maintaining Recredentialing, NPDB, & CAQH Terminations

Monitoring/Updating State License, DEA, Malpractice, Life Support, & Specialty Boards

Receiving/Updating Quality of Care Reports

Maintains provider changes for any provider within the OhioHealth organization

The major duties, responsibilities and essential functions listed above are not intended to be all-inclusive of the duties, responsibilities, and essential functions to be performed by associates in this job. Associate is expected to all perform other duties as requested by supervisor.

Minimum Qualifications:

Associate's Degree

Additional Job Description:

+ Associate's degree or equivalent experience

SPECIALIZED KNOWLEDGE

Requires knowledge of physician and allied health practitioner credentialing processes along with the ability to apply critical thinking skills to TJC and NCQA credentialing requirements. Exceptional organization and time management skills are required. The Program Coordinator is detail-oriented with the ability to work independently and apply independent judgement while working on multiple tasks. This role has an ability to understand and communicate requirements to others. The Program Coordinator has a high level of professionalism, with excellent verbal, interpersonal and written communication skills. Strong computer skills with high proficiency in Microsoft Office (Word, Excel, Outlook, PowerPoint) and database applications. A high level of initiative and ownership is required with the ability to self-motivate and work in a fast-paced environment. The Program Coordinator works well independently and in team settings.

DESIRED ATTRIBUTES

+ Associates Degree in a healthcare related field. Prior credentialing experience is preferred.

Work Shift:

Day

Scheduled Weekly Hours :

40

Department

Credentialing

Join us!

Equal Employment Opportunity

OhioHealth is an equal opportunity employer and fully supports and maintains compliance with all state, federal, and local regulations. OhioHealth does not discriminate against associates or applicants because of race, color, genetic information, religion, sex, sexual orientation, gender identity or expression, age, ancestry, national origin, veteran status, military status, pregnancy, disability, marital status, familial status, or other characteristics protected by law. Equal employment is extended to all person in all aspects of the associate-employer relationship including recruitment, hiring, training, promotion, transfer, compensation, discipline, reduction in staff, termination, assignment of benefits, and any other term or condition of employment

Remote Work Disclaimer:

Positions marked as remote are only eligible for work from **Ohio** .