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Position Classification Description

Position Class Code / Title: A5058 / Credentialing Coordinator
Recruitment Tier: Tier 1
FLSA: Non-Exempt
Grade: 10

This is a description of a Staff Position Classification. It is not an announcement of a position opening. To view descriptions of current openings, please go to UNMJobs and Search Postings to view positions that are currently accepting applications.

The following statements are intended to describe, in broad terms, the general functions and responsibility levels characteristic of positions assigned to this classification. They should not be viewed as an exhaustive list of the specific duties and prerequisites applicable to individual positions that have been so classified.

Summary

Responsible for leading, coordinating, monitoring, and maintaining the credentialing and re-credentialing process. Facilitates all aspects of UNM Health System credentialing, including initial appointment, reappointment, expirables process, as well as clinical privileging for Medical Staff, Allied Health Professionals, and all other providers outlined in the Health System Entity Medical Staff Bylaws, policies, or related contracts. Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws relating to credentialing. Responsible for the accuracy and integrity of the credentialing database system and related applications. Works under the supervision of the Credentialing Manager. This title is reserved for UNM Health System Centralized Verification Office (CVO).

Duties and Responsibilities

  1. Leads, coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility.
  2. Conducts thorough background investigation, research and primary source verification of all components of the application file.
  3. Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.
  4. Prepares credentials file for completion and presentation to Health System Entity Medical Staff Committees, ensuring file completion within time periods specified.
  5. Processes requests for privileges, ensuring compliance with criteria outlined in clinical privilege descriptions.
  6. Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and privileging issues as they arise.
  7. Assists with managed care delegated credentialing audits; conducts internal file audits.
  8. Utilizes the Cactus credentialing database, optimizing efficiency, and performs query, report and document generation; submits and retrieves National Practitioner Database reports in accordance with Health Care Quality Improvement Act.
  9. Monitors the initial, reappointment and expirables process for all medical staff, Allied Health Professional staff, Other Health Professional staff, and delegated providers, ensuring compliance with regulatory bodies (Joint Commission, NCQA, URAC, CMS, federal and state), as well as Medical Staff Bylaws, Rules and Regulations, policies and procedures, and delegated contracts.
  10. Performs miscellaneous job-related duties as assigned.

Minimum Job Requirements

  • High school diploma or GED; at least 6 years of experience with 4 years directly related to hospital medical staff or managed care credentialing. Certification/Licensure NAMSS Certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS) or actively pursuing certification.
  • Completed degree(s) from an accredited institution that are above the minimum education requirement may be substituted for experience on a year for year basis.

Knowledge, Skills and Abilities Required

  • Ability to communicate effectively, both orally and in writing.
  • Program planning and implementation skills.
  • Knowledge of related accreditation and certification requirements.
  • Knowledge of medical credentialing and privileging procedures and standards.
  • Ability to analyze, interpret and draw inferences from research findings, and prepare reports.
  • Working knowledge of clinical and/or hospital operations and procedures.
  • Informational research skills.
  • Ability to use independent judgment to manage and impart confidential information.
  • Database management skills including querying, reporting, and document generation.
  • Ability to make administrative/procedural decisions and judgments.

Conditions of Employment

  • Ability to become certified within one (1) year date of hire.

Working Conditions and Physical Effort

  • No or very limited exposure to physical risk.
  • No or very limited physical effort required.
  • Work is normally performed in a typical interior/office work environment.

The University of New Mexico provides all training required by OSHA to ensure employee safety.

Revised Date: 03/20/2017