Position Details Lakeland Regional Health is a leading medical center located in Central Florida. With a legacy spanning over a century, we have been dedicated to serving our community with excellence in healthcare. As the only designated Level 1 Trauma Center for Polk, Highlands, and Hardee counties, and the second busiest Emergency Department in the US, we are committed to providing high-quality care to our diverse patient population.
Our facility is licensed for 910 beds and handles over 200,000 emergency room visits annually, along with 49,000 inpatient admissions, 21,000 surgical cases, 4,000 births, and 101,000 outpatient visits. Active - Benefit Eligible and Accrues Time Off Work Hours per Biweekly Pay Period: 80.00
Monday - Friday Location : 1324 Lakeland Hills Blvd Lakeland, FL Pay Rate : Min $21.79 Mid $27.24
The Credentials Coordinator is responsible to the Manager, Medical Staff Services and works in conjunction with the Credentialing Supervisor. The Credentials Coordinator performs a variety of functions necessary to credential and privilege an array of provider types in accordance with Joint Commission, Medicare Conditions of Participation, NCQA/AAAHC and other managed care contract requirements/guidelines and best practices.
The coordinator utilizes technology to initiate provider credentialing applications, evaluate submitted applications for completion, review case logs to ascertain competency and perform critical verifications in order to prepare applicant files for a final review by the Credentials Committee. They work with department chairs/chiefs for clarification, and communicates with applicants, credentialing contacts and other related professionals throughout the process through both verbal and written communication methods.
The coordinator will evaluate requests for privileges and use a blend of credentialing knowledge and clinical familiarity to determine if an applicant meets the requirements for all requested privileges. The coordinator will communicate progress to internal and external customers and those involved in the onboarding process. The coordinator should identify red flags and escalate as appropriate.
They should identify opportunities for and contribute to the improvement of quality, safety and cost, as well as patient, customer, and employee satisfaction. Perform other related duties as assigned.
People At The Heart Of All We Do Fosters an inclusive and engaged environment through teamwork and collaboration. Ensures patients and families have the best possible experiences across the continuum of care. Communicates appropriately with patients, families, team members, and our community in a manner that treasures all people as uniquely created.
Safety And Performance Improvement Behaves in a mindful manner focused on self, patient, visitor, and team safety. Demonstrates accountability and commitment to quality work. Participates actively in process improvement and adoption of standard work.
Stewardship Demonstrates responsible use of LRH's resources including people, finances, equipment and facilities. Knows and adheres to organizational and department policies and procedures. Standard Work Duties: Credentials Coordinator Actively participates in team development, achieving dashboards, and in accomplishing department goals and objectives.
Evaluates requests for applications, assesses eligibility criteria and initiates initial and reappointment application files, including distant site credentialing, for physicians and advanced practice clinicians using knowledge of closed service levels. Utilize critical thinking skills to confirm accuracy of data entry in the application by applicants and verify information using knowledge of processes for system-generated, on-line and manual verifications.
Verifies education and training, when applicable, licensure, certifications, work history, exclusion and sanction information, malpractice history, peer references, hospital affiliations, etc. Documents verifications and follow-up notes in the credentialing system for all applicants. Communicates with applicants to resolve discrepancies between application data and verified information.
Completes consistent and timely follow up on all outstanding credentialing requirements and unsubmitted applications. Ensures privilege requirements are met, including review of clinical case logs, to ensure current competence of applicants. Demonstrate knowledge of all equipment and systems/technology necessary to complete duties and responsibilities.
Demonstrates knowledge how data fields in the credentialing software impact downstream reporting and interfaces, including accessioning of health system software systems and applications and patient facing provider directories. Maintain accurate up-to-date files for each practitioner. Maintain good working relationship with physicians and their office personnel.
Maintain confidentiality and privacy. Ensure all regulatory standards and requirements, including TJC, NCQA, AAAHC, etc. are met. Prepare, verify information, and invoice for application fees, as applicable.
Maintain current knowledge of office procedures, medical staff activities and department policies. Complete special projects as assigned. Organize job functions and work assignments to be able to effectively complete assignments within established time frames.
Demonstrated knowledge of all equipment and systems/technology necessary to complete duties and responsibilities. Other related duties as assigned. Competencies & Skills Essential: Strong critical thinking skills.
Proficiency with Microsoft Outlook, Excel Word and online faxing software with the ability to organize and manipulate data within Excel for the purpose of evaluation and reporting. Proficiency with Adobe Acrobat including the ability to create and manipulate PDF documents and forms. Ability to work independently and with a team.
Effectively multitasks and handles complex and varying workloads and changing priorities in an efficient manner through the use of strong organizational and time management skills. Understanding of the credentialing and privileging process in an accredited, inpatient hospital setting to include the requirements of both external regulatory entities and internal approval processes. Familiarity with healthcare industry regulatory agencies such as CMS, Joint Commission, NCQA, URAC, AAAHCand AHCA.
Works with external surveyors when needed for file audits. Knowledge of medical terminology, including basic anatomy and corresponding medical procedures as they appear on case logs. Ability to perform research as needed for new or unfamiliar procedures/terminology.
Strong written and verbal communication skills, including the ability to effectively communicate complex information in a concise but professional manner. Qualifications & Experience Essential: High School or Equivalent Nonessential: Associate Degree Other information: Experience Essential: - 2 or more years of experience in a professional office setting. - 1-3 years of healthcare credentialing or equivalent healthcare administrative experience. - Understanding of Medical Staff industry practices.
Experience Preferred: - 1 or more years of hospital medical staff office experience including applications and privileging. - Proficiency with Cactus Credentialing Software. - Current Certified Provider Credentialing Specialist (CPCS) Certification. - OSHA Working Standards.