Credentialing Coordinator

Candidates must have experience with ECHO and Cactus.

Key Responsibilities:

Oversee ED Call Schedule and manage committee meetings, including minutes, agendas, and scheduling.

Screen and pre-vet applicants, ensuring all credentialing data is accurate and complete.

Enter and maintain provider data in credentialing systems (Cactus, ECHO).

Audit completed credentialing applications and route files for departmental approval

Prepare credentialing files for committee review/approval and ensure compliance with bylaws and accreditation standards (TJC, NCQA, CMS, state/federal regulations).

Assist with OPPE/FPPE competency data and track expiring licenses/certifications.

Required Qualifications:

Minimum 3 years of experience in credentialing, compliance, audit, or healthcare administration.

Bachelor’s degree in a related field or equivalent experience/training.

Microsoft Office Suite, and data management.

Strong analytical, multitasking, and problem-solving skills with the ability to work under deadlines.

Ability to collaborate across departments and effectively communicate with stakeholders.

We need someone with the following experience:

Community hospital medical staff office

committee/department meeting management

ED call schedule

ECHO and Cactus skills are also desired

Certification Requirement:

Must obtain Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) within 18 months of hire.

Preferred Qualifications:

Experience in a community hospital setting.

Expert knowledge of accreditation and regulatory requirements (TJC, NCQA, CMS, etc.).

Proficiency in Cactus and ECHO credentialing systems

Background/experience in the following duties and responsibilities include:

ED Call Schedule, Committee meeting management including minutes, agenda and scheduling, screening applicants and pre-vetting, data entry into credentialing systems, experience with Cactus and ECHO systems, auditing completed credentialing applications, routing credentialing files for departmental approval, helps prepare files for committee review/approval, monitors file compliance under the bylaws, state/federal regulatory and accreditation agencies, assisting with OPPE/FPPE competency data, and monitoring expirables.

Job Function Summary:

Involves the development, implementation and monitoring of effective and efficient systems to facilitate all aspects of medical staff services and credentialing.

Provides for the processing of applications and verification of physician licensing and certifications.

May also involve the preparation of agendas and related materials for medical staff meetings and peer review activities.

May serve as the liaison between the medical staff and all hospital departments to coordinate and provide overall continuity of medical staff activities.

Monitors compliance with medical staff bylaws, rules, regulations, policies and procedures.

Initiates and cultivates partnerships with department management, medical staff and hospital leadership to ensure compliance and optimal efficiency for appropriate membership, credentialing and privileges for UCSF Health Saint Francis and St. Mary’s medical staff.

First responder to onboarding and revenue channel disruptions as well as performs auditing functions pursuant to facility bylaws, rules and regulations; credentialing policy and procedures; and other applicable accreditation/payor standards (e.g. NCQA, TJC, DHS, DMHC, CMS, delegated credentialing agreements, etc.).

Facilitates and supports committees and continuous performance improvement efforts to achieve department and organization goals/workplans.

Implements policy and procedures, provides training and orientations to a variety of constituents and supports efforts to sustain best practices.

Department Overview

The Office of Medical Affairs and Governance provides credentialing services for the UCSF Health System and is also responsible for privileging, governance and health plan enrollment for the Health System, including the Community Hospitals division (UCSF Health St. Mary’s and UCSF Health Saint. Francis Hospitals.

Key Responsibilities

50% Cultivate and produce efficient and compliant credentialing and privileging processes, such as:

Pre-application intake - Initiates credentialing process via the UC ME pre-application. Screens pre-applications for completeness and analyzes information to ensure the applicant’s record is set up correctly in our system.

Reviews, prepares and routes credentialing file for departmental approval. Identifies any credentialing issues discrepancies/ items that require extra analysis or information for departmental approval. Organizes and prepares information for committee review and approval.

Monitors file’s compliance with medical staff bylaws, rules, regulations, policies and procedure in addition to applicable federal, state and local regulatory and / or accrediting agencies by ensuring files are being credentialed within appropriate guidelines and time frame.

Reappointment/revalidation and related competency assessments (FPPE/OPPE).

Establishes and maintains licensures and credentials for clinical and privileged medical staff members. Notifies providers and department of expiring licensure and recommends further actions based on expiring licensure. Escalates provider with expired licensure to supervisor for suspension or privilege update as needed.

Process approval letters for various credentialing actions to ensure providers are made aware of the Credentials, Medical Executive Committee and Community Hospitals Board decisions.

25% Acts as a key resource for the credentialing committee and other medical staff committees. Collaborates with department chairs, hospital leadership regarding scope of practice and new privileges within clinical services/programs. Prepares agendas, minutes, reports, presentations, correspondence, emails, scheduling and logistics for committees’ functional responsibilities and delegated credentialing agreements.

20% Serves as the liaison between the medical staff, leadership and all hospital departments to coordinate all credentialing requests. In charge of building a professional relationship with medical staff to develop new approaches or methods for maintaining effective communication.

5% Provides administrative support for medical services offices. Coordinates and implements large, ongoing administrative projects to ensure processes are efficient. Other duties as assigned.

Knowledge Skills and Abilities (KSAs)

Proven ability to apply external regulatory guidelines and internal accounting and administrative policies knowledge and skills to assess and monitor compliance and effectiveness of processes. Req

Solid skills to evaluate issues and identify solutions. Demonstrated ability to solve problems and suggest solutions through critical thinking processes. Req

Ability to independently set and meet deadlines while multi-tasking and assigning precedence to competing priorities. Ability to see multiple assignments through to completion on deadline. Req

Skills to work collaboratively coordinate and integrate with others throughout the department, hospital and campus. Ability to communicate through all mediums and with all groups and work under pressure of constantly changing deadlines and priorities. Req

Ability to perform all commonly applicable functions in Microsoft Office Suite (Word, Excel, PowerPoint) and medical credentialing database application. Req

Thorough knowledge of data management and documentation methods used in medical credentialing. Req

Minimum of three years relevant work experience in a similar environment (i.e.: audit, credentialing, compliance, healthcare, quality, process improvement). Req

Advanced competency in a paperless computer environment and understanding of provider data integrity standards (credentialing software, MS Office suite, Adobe Professional, document scanning/storage, web-based applications, and tools, etc.) Req

Role models and promotes best practices to maintain confidentiality and discretion to preserve

HIPAA/Peer review protections as well as attorney-client privilege, as warranted. Req

Experience working in a community hospital environment. Pref

Expert knowledge of TJC, NCQA, CMS, DHS, DMHC, ACCME and other applicable accreditation/regulatory requirements Pref