Delaware Resource Group

  • Physician Credentialing Coordinator

    Job Locations US-OK-Oklahoma City
    Posted Date 2 weeks ago(11/1/2018 2:12 PM)
    Job ID
    2018-1914
    # of Openings
    3
    Category
    Medical
  • Overview

    Interested in working for a growing level 1 trauma center?  

     

    DRG Professional Services is partnered with Oklahoma’s largest and most comprehensive health system offering expertise in more medical specialties than any other hospital system in the state.  The hospital is experiencing incredible growth and expending thier credentailing team.   This is a direct hire, long term position located in Oklahoma City. 

     

    Responsibilities

    The Creditionaling Coordinator under general direction, initiates verification of initial and reappointment applications and coordinates and maintain medical staff databases for credentialing and verification needs.

    • Initiate verification processes of Medical Staff initial and reappointment applications to include standardized, cost-effective verification that comply with JCAHO and other regulatory agency standards.
    • Responsible for the credentialing application process of physicians, allied health and other practitioners with the health plans.
    • Maintain provider credentialing files and information such as medical license, DEA, malpractice faces sheets, etc.
    • Maintains current copy of all medical staff bylaws, rules and regulations and is knowledgeable of hospital bylaws and rules and regulations relating to credentialing processes.
    • Establishes procedural criteria according to bylaws, rules and regulations; and ensures requirements for staff privileges are maintained
    • Collecting and maintaining an accurate practitioner database and analyzing verification information to ensure maximum revenue generation.
    • Acts as liaison between Managed Care/Credentialing, Billing and the insurance carriers.
    • Maintains knowledge of insurance company's requirements, regulations, and processes regarding credentialing.
    • Maintaining compliance with regulatory and accrediting bodies.
    • Participates in the development and implementation of credentialing processes.
    • Responsible for adhering to and applying NCQA Standards and AAAHCA Standards of credentialing.
    • Responsible to maintain knowledge of medical/legal issues, state and federal guidelines, and regulatory agency guidelines as they relate to credentialing, peer review and compliance issues.
    • Provides accurate medical staff databases to the facility as well as other facility specific reports upon request.

     

    Qualifications

    • Must have credentialing or medical staff coordinator experience. 

    The Company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, genetic information or any other characteristic protected by law.

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