Credentialing Coordinator IV

As a community, the University of Rochester is defined by a deep commitment to Meliora - Ever Better. Embedded in that ideal are the values we share: equity, leadership, integrity, openness, respect, and accountability. Together, we will set the highest standards for how we treat each other to ensure our community is welcoming to all and is a place where all can thrive.

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The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job's compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations.

Responsibilities:

ESSENTIAL FUNCTIONS

• Audits, analyzes, and monitors credentialing application/files processed by Credentialing Specialist staff to ensure appointments are processed in required timeframes, including all required primary source verifications and accompanying documentation, to ensure files meet regulatory requirements.
• Documents and tracks performance statistics of the Credentialing Specialists application processing related to accuracy and communicates with the managers when issues are identified. Reviews statistics regarding performance measures and goals with management regularly and assists with identifying trends. Trains new and existing staff on how to process initial and/or reappointment/re-credentialing applications.
• Determines practitioner eligibility for membership/participation or changes in status. Analyzes application and supporting documents for accuracy and completeness and informs the practitioner of the application status, including the need for any additional information or corrections. Obtains, researches, and evaluates information from primary sources to ensure compliance with accreditation and regulatory standards to validate accuracy of applications for one or more decision making bodies, including a thorough background investigation and primary source verification of all components of the application file, such as applicant's education and training, licensure, work history, hospital affiliation history, malpractice claims history, board certification status, criminal background, evaluation of health status, and peer recommendations. Recognizes, investigates, and validates discrepancies and adverse information obtained during the application process to ensure review and approval bodies have information needed to make informed credentialing decisions.
• Reviews file for accuracy and completeness before submission. Electronically routes the credentials files to the department chief/chair or designee for review and recommendation for membership and privileges for Strong Memorial Hospital and Highland Hospital. Coordinates expedited credentials committee and board approval process for credentials files being recommended by the departments for Strong Memorial Hospital and Highland Hospital. Coordinates emergency privilege requests for hospital privileges as needed for all UR affiliates. Prepares practitioners credentials files for presentation to affiliate and non-affiliate CVO clients and coordinates the electronic routing through the credentialing software or other secure electronic process.
• Assists the Credentialing Coordinator with the enrollment of liability insurance for qualified practitioners as needed. Assists the Credentialing Coordinator with the National Practitioner Data