Credentialing Coordinator
Milwaukee, WI 
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Posted 1 day ago
Job Description
Job ID 174579
Specialty / Department

Clinician Srvs And Recruitment

Full / Part Time Full-Time
Hours / Bi-weekly Pay Period 80
2019-06-26
Location
  • MKE 3000 W Montana St
    3000 W Montana St Milwaukee, WI 53215
How You'll Make a Difference

Coordinates credentials verification and analysis activities to support appointment, reappointment and other credentialing activities to the practitioners of the medical staff of all Aurora Health Care hospitals, surgical clinics and health network, and external customers.


Evaluates requests for applications and obtains authorization as needed. Determines appropriate action to accept or deny application requests. Initiates application process.

Processes applications, reappointments and other credentialing events to the Medical Staff/Network, assessing practitioner information to determine the presence of potentially adverse information and determines further action required. Responsible for quality control on the content and completeness of finalized practitioner credentials files.

Coordinates biennial review, ensuring each practitioner seeking reappointment is evaluated according to requirements by external accreditation and regulatory standards.

Documents all work performed for credentialing events in database as part of the communication with internal customers.

Communicates the progress, completion and findings of ongoing applications to leadership, and as appropriate to other customers. Identifies evolving issues of concern and takes appropriate action.

Maintains credentialing database according to department policies and procedures and regulatory guidelines. Provides an electronic historical record of credentialing events within the organization.

Responsible for investigation and documentation of practitioner credentials, utilizing specialized knowledge to obtain verification of all aspects of a practitioner's background, training and past practice. Understands credentialing requirements of both The Joint Commission and NCQA, CMS and other governmental requirements, and performs in accordance with these standards.

Generates and maintains accurate documentation that may be reviewed and judged for acceptability by state and federal licensing agencies, external customers and may be called into a court of law to justify decision-making by Aurora entities. Manages external audits for delegated credentialing contracts, prepares and reviews files, transmits to delegate, demonstrates adherence to NCQA standards through individual credentialing records.

Evaluates privilege requests to ensure that required supporting documentation named in privilege criteria is included.

Deals with customer questions and complaints by Aurora Health Care caregivers, physicians, allied health practitioners and external agencies.

At Aurora Health Care

We pride ourselves on taking care of our people. And not just our patients—we mean you, too. We help each other live well. When you work at Aurora, you get the chance to work with a dedicated team that’s as passionate about the work as you are. Here, you’ll find limitless opportunities for ongoing learning, career advancement, competitive compensation and a stable work environment. But more than that, you have the opportunity to change lives—including your own.


Diversity and inclusion matters at Aurora. We celebrate our differences and nurture an environment where everyone feels included. We know that when we reflect the communities we serve, when we embrace differences and bring our whole selves to work every day, we are working as one to build a healthier tomorrow for everyone. Aurora supports a safe, healthy and drug-free work environment through criminal background checks and pre-employment drug testing. We maintain a smoke-free environment at all our locations. We are an equal opportunity employer.

 

Job Summary
Start Date
As soon as possible
Employment Term and Type
Regular, Full or Part Time
Required Experience
Open
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