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8110 Gatehouse Road, Falls Church, VA 22042

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Centralized Credentialing Coordinator

Cambridge Court 640051 Full Time 8110 Gatehouse Road, Falls Church, VA, 22042, US
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Job Description

The Centralized Credentialing Coordinator completes the credentialing process for medical staff membership and/or clinical privileges in accordance with the appropriate Joint Commission standards and other regulations. Identifies extraordinary information, discrepancies, time gaps and obtains additional explanation and information as required. Provides assistance with questions and directs staff to appropriate resources to educate. Assists with orientation of new staff. Assists with training new staff as needed. Participates in interviews for new team members. Assists with special projects within the department as needed. Sends reports to Medical Staff Offices and Manager/Supervisor as needed. Maintains and updates standard work manuals. Plays a proactive role in process improvement.

Job Responsibilities

  • Processes practitioner applications for initial appointment and/or reappointments.
  • Manages, supports and maintains credentials files on all medical staff members and advanced practice providers. Consults and works with other hospital departments to coordinate process.
  • Assures compliance with regulatory requirements and accrediting body standards, Bylaws and policies. Consistently reviews regulatory requirements, accreditation body standard, Bylaws and policies to maintain current knowledge.
  • Initiates and processes applications within required timeframe per policy.
  • Thoroughly reviews and evaluates applications with minimal items missed per policy.
  • Plays a proactive role in improving processes within department for maximum efficiency by participating/leading process improvement activities.
  • Communicates status of application to practitioners and all interested parties on a regular basis per policy.
  • Appropriately identifies extraordinary information, time gaps and potential discrepancies and adverse information, and independently investigates and validates information on applications, primary source verifications or other sources.
  • Notifies appropriate individuals of identified problems as soon as extraordinary information is determined.
  • Conducts follow-up and research regarding additional required information. Documents appropriately.
  • Provides excellent customer support to internal and external clients including prompt responses to requests for information/help.
  • Manages, supports and maintains the Network Insurance Credentialing process for appropriate Employed practitioners.
  • Completes audit updates on Network Insurance files within expected timeframe.
  • Obtains additional information for all Network Insurance applications with pending and closed lawsuits per policy.
  • Accepts credit card payments and follows Inova’s policy regarding processing of the payments.
  • Works to ensure applications are completed within the required timeframe to meet the appropriate Credentialing Committee Deadlines whenever possible.
  • Reviews personal tracking list to determine files that are ready to have a final review completed to prevent delay in completing credentialing process.
  • Reviews Privilege request forms for accuracy and provides criteria as appropriate. Notifies practitioner that privilege will be withdrawn if criteria not received by deadline.
  • Complete evaluation of pre-application/application to determine applicant’s initial eligibility for membership.
  • Maintain credentialing database continuously and consistently to ensure that accurate and current information is available to all stakeholders.
  • Maintain confidentiality regarding legal matters, privacy issues, information technology, and data integrity.
  • Provides mentorship to credentials specialists.
  • Provides assistance with questions and directs staff to appropriate resources to educate.
  • Assists with orientation of staff and provides direction to department resources.
  • Assists with departmental special projects.
  • Assists with high priority applications to expedite processing.
  • Assists with departmental special projects.
  • Assists with high priority applications to expedite processing.
  • Master's the MSOW system and provides training, re-training and guidance to staff and other users as appropriate.
  • Reviews and thoroughly evaluates applications.
  • Maintains current knowledge of and assures compliance with regulatory requirements and accrediting body standards.
  • Supports other projects and duties as assigned.


Additional Requirements

N/A