Credentialing Coordinator/Specialist, UCLA Health, Los Angeles, CA

Posted on November 12th, 2019

UCLA Health serves to bring together and develop the very best, brightest and caring people in healthcare.  Along the way, we are here to help provide you with an outstanding professional work experience matched by highly competitive pay and benefits, and professional resources to help you reach your full potential.

The Credentials Coordinator/Specialist is responsible for receipt, review, and analysis of online submissions related to Allied Health/Medical Staff appointments/reappointments, accurate data entry into the automated system, review, analysis, and comparison of electronic/database submissions, primary source verification queries via electronic and manual methods, follow-up for delinquent responses, maintenance of electronic and paper files, and appropriate response to practitioner and other client inquiries.

The Credentials Coordinator/Specialist is under the supervision of the Director, Credentials Verification Unit, and is able to work independently and in collaboration with the Credentials Verification staff, Medical Staff Offices, and Clinical Service Coordinators.

Functions as analyst of online credentialing application submissions

A. Receive, review, and analyze all incoming electronic applications and documents to assure that they meet credentialing requirements:

• Receive, review, and analyze incoming submissions and hard-copy documents and applications as well for completeness and appropriateness of contents.
• Receive and date stamp hard copy documents and applications as well for data entry.
• Follow up with client Medical Staff Offices, practitioners and other respondents regarding incomplete/missing information on submissions as well as hard copy documents received.  Independently make decisions regarding whether information meets CVO, JCAHO and NCQA requirements related to content, completeness and timeliness.

B. Track and facilitate timeliness of workflow:

• Generate daily AR reports and review for applications exceeding processing standards.
• Identify applications requiring urgent processing and assure prompt, complete and accurate processing.
• Initiate data quality review of electronic application submissions and analyze and compare to data currently in the database. Update database as applications are received.  Assure accurate and timely updates.

C. Support the process to credential/recredential applicants to the Allied, Medical and Professional Staffs.

• Review and analyze the content of all electronic submissions, as well as hard copy documents, received for an applicant to assure they provide a consistent record of practitioner activity, are complete and accurate.
• Enter all data into the database accurately.
• Identify and communicate potential problems.
• Perform primary source verification using on-line electronic systems, as well as dispatching letters and queries accurately and timely.

D. Maintain the electronic data base and hard copy files.

• Document all responses received, following protocol for analyzing and noting inconsistencies and items requiring further investigation.
• Follow CVO policies for data entry.
• Review online application materials for appropriateness and database updates. Compare and analyze the data submitted to the data currently in the database. 
• Process all electronic submissions and hard copy documentation promptly and within time frames indicated in CVO policies and procedures.
• Evaluate the completeness and integrity of on-line application submissions prior to accepting, adding and/or updating the information in the database.
• Identify and repair inaccurate data entries.

E. Participate in generation and dispatch of applications.

• Enter practitioners to database accurately and appropriately.
• Compile electronic documents and dispatch to applicant.
• Compile and dispatch paper documents to applicant.
• Respond correctly to practitioners’ calls regarding the credentials verification process.  Follow through on problems and inquiries beyond the scope of the CVO.

Contact Information:
All inquiries and resumes can be sent to Jsiguenza@mednet.ucla.edu  or apply at (https://www.uclahealthcareers.org/ucla-health-careers-home/)   Job Posting# req4383