Salt River Pima-Maricopa Indian Community

Scottsdale, Arizona, United States

Medical Staff & Credentialing Coordinator

Posted over 1 month ago · Full time

Job Description


Under direct supervision of the Quality and Compliance Administrator, this position ensures seamless onboarding and off-boarding of all medical staff at the River People Health Center (RPHC). Specifically related to the privileging and credentialing and re-credentialing of providers (i.e. physicians, physician assistants, ARNPs, dentists, clinical counselors, etc.) in accordance with applicable licensing board and/or accreditation standards. This job class is treated as FLSA non-exempt.

Essential Functions : Essential functions, may vary among positions, but may include the following tasks, knowledge, skills, abilities and other characteristics. This list of tasks is ILLUSTRATIVE ONLY and is not intended to be a comprehensive listing of tasks performed by all positions in this classification.

Examples of Tasks
  • Maintain compliance with documentation standards for verification of provider employee credentialing requirements, including but not limited to, licenses, certifications, registrations, permits, educational degrees, internship, residency and association memberships, and any related electronic systems and software.
  • In coordination with HR, ensures all required backgrounds and re-verifications are performed during hiring and thereafter. (i.e. National Practitioner Data Bank)
  • In ensures all records including Continuing Education are properly kept for all providers
  • Collects, enters and ensures data in the credentialing data base is updated
  • Reviews and screens initial and reappointment credentialing applications for completeness, accuracy, and compliance with federal, state, local and organizational regulations, guidelines, policies, and standards.
  • Conducts primary source (or secondary source) verification, collects and validates documents to ensure accuracy of all credentialing elements; assesses completeness of information and qualifications relative to credentialing standards.
  • Identifies, analyzes and resolves discrepancies, time gaps and other idiosyncrasies that could adversely impact ability to credential and enroll providers; discovers and conveys problems to Supervisor.
  • Monitors files to ensure completeness and accuracy; reviews all file documentation for compliance with quality standards, accreditation requirements, and all other relevant policies; prepares and provides information to internal and external customers as appropriate.
  • Enters, updates and maintains data from provider applications into credentialing database, focusing on accuracy and interpreting or adapting data to conform to defined data field uses, and in accordance with internal policies and procedures.
  • Prepares, issues, electronically tracks and follows-up on appropriate verifications for efficient, processing of individual applications in accordance with applicable credentialing standards, established procedural guidelines, and strict timelines.
  • Participates in the development and implementation of process improvements for the organization-wide credentialing process; prepares reports and scoring required by regulatory and accrediting agencies, policies and standards.
  • Performs miscellaneous job-related duties as assigned.
  • Participates in site visit(s) for credentialing purposes as well as programmatic audits as required
  • Running reports on all credentials/expirables such as licenses, DEA's, CPR certificates, etc. and maintaining current copies
  • Provides consistent, accurate, and timely credentialing support for Center's accreditation process
  • Acts as coordinator for furthering any and all Center's wide certifications it may decide to pursue
  • Provides accurate, timely and documented verification of the information provided by new applicants as well as current providers
  • Assists with the onboarding process of medical, dental and behavioral health service providers
  • Verifies, researches, and responds to telephone and written inquiries from providers and other departments, pertaining to provider participation and credentialing status
  • Prepares and maintains reports on all accreditation and credentialing activities as required
  • Works in conjunction with CMO (or designee) and Quality Administrator to develop Medical Executive Committee Agenda and keep minutes.
  • In conjunction with the CMO, Quality Administrator and Medical Executive Committee make updates to Medical Staff Bylaws, Rules and Regs and Policies.
  • In conjunction with the Quality Administrator, ensures Center's credentialing process fully complies with HIPAA and applicable accreditation body.
  • Monitor and assure compliance with medical staff bylaws, rules and regulations, and policies and procedures.
  • Collaborates and shares information with finance department on Payer Enrollment processes.
  • Serve as a liaison between the medical staff and all RPHC service lines to coordinate and provide overall continuity of medical staff activities

Knowledge, Skills, Abilities, and Other Characteristics:
  • Knowledge of the history, culture, laws, customs and traditions of the SRPMIC.
  • Knowledge healthcare credentialing and privileging.

  • Skill in analyzing data from multiple sources
  • Skill establishing and maintaining effective working relationships with medical staff and leadership.
  • Skill with verbal and written communication, numbers and record keeping
  • Skill using personal computer and related software.
  • Skill in solving problems through the use of a combination of delivered and custom-developed tools.
  • Skill in time management and organization.

  • Ability to code, compile and categorize, and verify information/data.
  • Ability to work independently, take initiative and use judgment.
  • Ability to meet and comply with HIPAA/Confidentiality policies and procedures and ability to handle highly confidential and sensitive information.
  • Ability to complete work assignments and special projects in a timely manner.

Minimum Qualifications
  • Education and Experience: Associates Degree, Bachelor's degree preferred, equivalent and 2 years full-time experience in managing credentialing, privileging, or similar healthcare professional verification and organization's accreditation processes are required
  • NAMSS Credentialing Specialist Certification or Certification is preferred.
  • E quivalency: Equivalent combinations of education and experience that will allow the applicant to satisfactorily perform the duties of the job may be considered.
  • Underfill Eligibility: An enrolled Community Member whom closely qualifies for the minimum qualifications for a position may be considered for employment under SRPMIC Policy 2-19, Underfill

Special Requirements

  • Employees in, and applicants applying for, jobs providing direct services to children are subject to the "Community Code of Ordinances", Chapter 11, "Minors", Article X. "Investigation of Persons Working With Children".

Prior to hire as an employee, applicants will be subject to drug and alcohol testing. Will be required to pass a pre-employment background/fingerprint check. Employees are subject to random drug and alcohol testing.

"SRPMIC is an Equal Opportunity/Affirmative Action Employer" Preference will be given to a qualified Community Member, then a qualified Native American and then other qualified candidate.

In order to obtain consideration for Community member/Native American preference, applicant must submit a copy of Tribal Enrollment card or CIB which indicates enrollment in a Federally Recognized Native American Tribe by one of the following methods:

1) attach to application

2) fax (480) 362-5860

3) mail or hand deliver to Human Resources.

Documentation must be received by position closing date. The IHS/BIA Form-4432 is not accepted . Your Tribal ID/CIB must be submitted to HR-Recruitment-Two Waters.

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