Credentialing Coordinator

Benefits

Additional Information

Pay range: $25.18 - $37.77 per hour, based on experience. In addition, this role is eligible to work remotely from an approved state by St. Charles (please refer to the list). If you do not reside in an approved listed state (or do not plan to relocate to an approved listed state) we request, you do not apply for this particular position. Approved states by St. Charles: Oregon, Arizona, Arkansas, Florida, Idaho, Missouri, Montana, Nevada, New Mexico, North Carolina, Oklahoma, Tennessee, Utah, and Wisconsin. This full-time position comes with a comprehensive benefits package that includes medical, dental, vision, a 403(b) retirement plan, and a generous Earned Time Off (ETO) program. ST. CHARLES HEALTH SYSTEM JOB DESCRIPTION TITLE: Credentialing Coordinator REPORTS TO POSITION: Credentialing Manager DEPARTMENT: Medical Staff Services DATE LAST REVIEWED: May 2025 OUR VISION: Creating America's healthiest community, together OUR MISSION: In the spirit of love and compassion, better health, better care, better value OUR VALUES: Accountability, Caring and Teamwork DEPARTMENT SUMMARY: The Medical Staff Services (MSS) Department of St. Charles Health System is the gatekeeper of patient safety within the healthcare industry. The professionals working in Medical Staff Services serve as the experts in matters of credentialing/ privileging and medical staff governance within the healthcare community. This foundation is the basis upon which safe and quality care can be assured for patients. POSITION OVERVIEW: The Credentialing Coordinator coordinates the processes for medical staff/advanced practice professional credentialing, privileging, delegated payer, and allied health professional credentialing to ensure that legal and regulatory requirements are met at all St. Charles Health System's facilities. Exercises judgment and discretion in recognizing legal implications and patient safety issues through the credentialing and privileging functions. Collects and prepares detailed information to report potential quality of care issues and behavioral problems to ensure safety and quality for all patients who receive care within St. Charles Health System. This position does not directly manage any other caregivers. ESSENTIAL FUNCTIONS AND DUTIES: Complies with internal and external policies, guidelines and standards. Verifies and collects documents that support providers have met and maintain the eligibility threshold for their privileges. Finds, investigates and reports any possible flags, patterns of negligent patient care, and negative behavior and notes all findings. Processes initial and reappointment applications and privileging requests as defined by internal and external policies, procedures and guidelines. Must be knowledgeable of the Medical Staff Bylaws and Rules and Regulations, The Joint Commission, CMS, and NCQA guidelines, URAC and Oregon State Law. Ensures processes are coordinated timely and accurately in compliance with schedules. Organizes and maintains provider files including obtaining current/updated copies of essential documents, loading/scanning all documents which contain confidential and peer protected data and documents. Updates individual files in company credentialing software and databases while adhering to the established data entry conventions. Interfaces and maintains professional relationships with applicants, Medical Staff leadership, state professionals and licensing bodies, and other partnering St. Charles leadership and departments as needed. Creates accurate credentialing reports with proper information so the Medical Staff Credentialing Committees can review and make appropriate recommendations to St. Charles Health System governing bodies for medical staff membership and privileging approvals, denials, suspensions or revocations. Creates accurate delegated payer credentialing reports for the Medical Director (or designee) and the Delegated Payer Credentialing committee. Maintains provider records for auditing, and maintains close communication with all appropriate practitioners to ensure that files are returned on time, records are up-to-date, consistent and complete. Tracks status of responses, identifies any discrepancies in information and conducts follow up if applicable. Collaborates with provider to obtain any missing items and will provide a status update on the application and/or privileges. Maintains working knowledge of Medical Staff governance and flow of information throughout the Medical Staff Structure and the Health System's leadership to ensure patient safety. Maintains and protects the confidential records of the credentialing and privileging processes which may be required in subsequent internal investigations and/or external legal disputes. Handles and protects sensitive peer protected and confidential information with the highest level of integrity. Exercises a high degree of independent judgment and initiative in response to complex, sensitive

Your Match

How well this role fits your profile.

Company Intel

What employees say

Worked at stcharles? Share your experience