Credentialing Coordinator

Mass General Brigham (Enterprise Services)
United States, Massachusetts, Somerville
399 Revolution Drive (Show on map)
Jan 01, 2025
General Overview The Credentialing Coordinator is primarily responsible for tracking and maintaining credentialing expirable documents. Responsible for the administrative duties required for the credentialing verification process. The Credentialing Coordinator also assists with activities associated with physician and advanced practice provider's credentialing and re-credentialing. Reviews, enters, and maintains credentialing information in the MGB Enterprise credentialing system. Ensures the credentialing process complies with organizational as well as accrediting agency, Federal and State regulatory standards. Principal Duties and Responsibilities - Track and maintain credentialing expiring documents including, but not exhaustive: medical licenses, professional licenses, MCSR, DEA, Insurance, ACLS, BLS, PALS, and NRP - Compare primary source verified information with the information within the electronic record and enter data in the Enterprise credentialing system accurately - Provide Credentialing Director with weekly updates on any missing or delinquent items as part of the expirable process - Utilize credentialing websites to obtain primary source verifications - Run reports to identify non-compliant items and run system verifications, if needed - Responsible for maintaining the integrity of provider data in the Enterprise credentialing system through ongoing monitoring and by ensuring data is entered and updated accurately - Identify issues that require additional investigation and evaluations - Communicate with internal and external physicians, allied health professionals, other healthcare professionals, and managers regarding questions or issues in an effort to gather and maintain credentialing information - Assist Credentialing Specialist with initial and reappointment application in accordance with the CCO policies and procedures - Performs routine credentialing application audits for quality, completeness, and accuracy of data - Assist with verifying credentialing elements, including but not limited to, education, training, board certification, work history, licensure and certifications, malpractice coverage - Assist Credentialing Specialists with following-up on missing data to ensure that the credentialing application is completed within an established time frame - Analyze application material to assure that providers data is accurate in the electronic records - Complete special projects as assigned - General administrative tasks and other duties as assigned High school diploma or equivalent. Associate's or Bachelor's Degree in a related field preferred One year of experience in credentialing services or related field Skills, Abilities and Competencies Working knowledge of general office practices, software applications and database management Demonstrated understanding of credentialing policies Organizational skills required to handle high data flow and to prioritize tasks in order to meet deadlines Ability to manage demanding workload; self-motivated; able to carry out responsibilities with minimum supervision Analytical skills necessary to determine whether correct and complete information was provided on applications. Able to concentrate on tasks, paying meticulous attention to detail regardless of distractions Possesses ability to manage specialized database including producing credentialing reports Adheres to professional confidentiality standards in accordance with legal, ethical, and departmental policies Handles sensitive and confidential situations/information, with a high degree of tact and diplomacy Communicates effectively and professionally with applicants or colleagues by telephone or in person Mass General Brigham Incorporated is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.