Coordinator, Credentialing Quality & Delegation - Legal - Full Time

As a Credentialing Quality & Delegation Coordinator, you'll play a key role in system wide compliance. From coordinating with Joint Commission, State Regulations and Bylaws your partnership will ensure compliance with regulatory standards, your attention to detail will show support in many ways. If you thrive in a fast-paced environment and enjoy being the organizational backbone of a dedicated healthcare team, this is your opportunity to make a meaningful impact.

Recognized as a Top Healthcare Employer

Guthrie is consistently recognized for its strong workplace culture and commitment to caregiver well-being, including:

• Best Places to Work 2025 – Modern Healthcare
• America's Greatest Workplaces in Healthcare 2025, 2026 – Newsweek
• America's Best-In-State Employers (PA) 2025 – Forbes
• America's Best Employers for Healthcare Professionals 2025 – Forbes
• America's Best Employers for Women 2025 – Forbes

Schedule & Coverage

Full-Time, Day Shift

Benefits That Matter

• Medical, Dental, and Vision coverage starting the first of the month after hire
• PTO starts Day 1
• Voluntary 403(b) Retirement Plan with Employer Match through Fidelity
• Employee Assistance Program providing confidential support for personal and professional well-being
• Shift Differentials and Premiums for evenings, nights, weekends, and float coverage
• Friendly, inclusive work family where you'll feel valued and supported

Summary:

The Credentialing Quality & Delegation Coordinator ensures system-wide compliance with Joint Commission (TJC), NCQA, CMS, state regulations, and Medical Staff Bylaws governing provider credentialing, privileging, and delegated payer arrangements. This position leads system-level audit and quality initiatives, manages delegated credentialing agreements and rosters, and sustains continuous readiness across all Guthrie entities. The role also serves as Guthrie’s primary liaison to payers, delegated entities, and accrediting bodies, ensuring credentialing integrity, audit readiness, and operational excellence across all facilities.

Key Partnerships

• Medical Staff Office (MSO) Managers and Credentialing Coordinators (all hospitals)
• Quality and Patient Safety
• Compliance and Corporate Risk
• Revenue Cycle and Payer Relations
• Employee Health and Human Resources
• Department Chairs, Chiefs, and Medical Executive Committees (MECs)
• Legal, IT, and Analytics Teams

Authority and Decision Rights

• Holds system-level authority to pause or return credentialing files, rosters, or privilege forms that do not meet regulatory, bylaw, or delegation standards.
• Provides final quality sign-off on delegated rosters prior to payer submission.
• Leads corrective action plans (CAPs) for credentialing, privileging, and delegation findings; escalates unresolved risks to the Director of Medical Staff Services and MEC.
• Serves as system data steward for CredentialStream and related credentialing databases.

Experience:

• Minimum 3–5 years of progressive experience in medical staff credentialing, healthcare quality, or compliance, preferably within a multi-hospital system.
• Proficiency in CredentialStream (or equivalent system) and Microsoft Office 365.
• Strong understanding of TJC, NCQA, CMS, and state credentialing requirements.
• Familiarity with payer delegation audits and roster management processes.

Education:

Associate’s degree required; Bachelor’s degree preferred (Healthcare Administration, Business, or related field).

Licenses:

NAMSS CPCS or CPMSM certification preferred; required within 12 months of hire.

Essential Functions:

1. Regulatory Compliance & Quality Oversight

• Ensure that all credentialing and privileging processes across Guthrie hospitals and entities comply with TJC, NCQA, CMS, and state/federal regulations, as well as Medical Staff Bylaws.
• Conduct proactive, periodic, and targeted audits of provider files to ensure accuracy, completeness, and primary source verification integrity.
• Verify compliance with required credentialing elements, including:
  • Licensure, board certification, DEA, CSR, and malpractice coverage
  • CME (≥50 CEUs at initial and reappointment per bylaws)
  • Health status documentation at both initial and reappointment
  • OIG/SAM/state exclusion checks and NPDB queries
  • Medicare opt-out and sanctions verification
  • Stroke education tracking for applicable providers (NYS Stroke Center compliance)
• Track, report, and trend compliance findings; develop CAPs and monitor resolution to effectiveness.
• Maintain survey-ready documentation and evidence binders for all accreditation bodies.

2. Delegation & Payer Roster Management (NCQA)

• Maintain an inventory of all delegation agreements (scope, elements, and audit cadence) for all payers and delegated entities.
• Lead pre-delegation assessments, annual NCQA delegation audits, and CAP tracking through closure.
• Maintain and submit accurate delegated rosters system-wide, ensuring payer-specific formatting, timeliness, and reconciliation of acceptance or rejection feedback.
• Serve as Guthrie’s primary liaison with payers and delegated entities, ensuring readiness for both announced and unannounced audits.
• Collaborate with Revenue Cycle, Compliance, and Payer Relations to ensure delegation terms remain current and compliant.

3. Credentialing Operations & Data Integrity

• Serve as system Credentialing Software’s data steward, ensuring data uniformity, accuracy, and completeness across all Guthrie facilities.
• Manage and monitor all expirable credentials and maintain compliance dashboards system wide.
• Standardize credentialing workflows and documentation practices across all hospitals, ensuring shared templates, audit trails, and compliance with bylaws.
• Partner with MSO leadership to streamline handoffs for initial appointment, reappointment, FPPE/OPPE, and privilege revisions.

4. Governance & Committee Support

• Support system and facility-level Credentials Committees and Medical Executive Committees (MECs) by preparing agenda packets, audit summaries, and compliance reports.
• Document meeting outcomes, recommendations, and follow-up actions, ensuring timely resolution and regulatory compliance.
• Provide real-time guidance on credentialing and privileging requirements during committee deliberations.

5. Leave of Absence (LOA) & Status Management

• Maintain system-wide tracking for provider leaves of absence, resignations, and reactivations, in collaboration with HR and department leadership.
• Ensure FPPEs are completed for all providers out of practice greater than six months, with recredentialing prior to reactivation.
• Update system databases and rosters accordingly to maintain accuracy and compliance.

6. Education, Collaboration, and Continuous Readiness

• Provide training and education for credentialing and MSO staff on audit standards, delegation requirements, and data integrity practices.
• Partner with Quality and Compliance to maintain continuous survey readiness and standardized audit tools across all hospitals.
• Lead system improvement initiatives focused on efficiency, documentation consistency, and data accuracy.
• Maintain and report Key Performance Indicators (KPIs) to system leadership on a quarterly basis.

Performance Metrics (KPIs)

• Audit Compliance: ≥95% pass rate on internal quality audits
• Roster Timeliness: 100% of delegated rosters submitted on time
• Expirable Compliance: ≥98% current at all times
• Data Integrity: ≥99% accuracy in CredentialStream
• CAP Closure: 100% corrective actions closed by due date
• Survey Readiness: No repeat or high-severity findings across audits

Other Duties:

Other duties as assigned

The pay range for this position is $29.62-$45.02/hr. based on experience.

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