Credentialing Coordinator 1

Mercyhealth • Rockford, IL

22h • Hybrid

About The Position

Credentialing Coordinator, Medical Staff Office, Days, 80 Hrs / 2 wks
Location: Mercyhealth Rockton. Hybrid work schedule opportunity avaliable after training period.
Performs duties related to the Medical Staff Office functions, which include but are not limited to credentialing new and established healthcare providers, maintaining information which includes primary source verification, follow-up, data collection, data entry, and document review. Participates in all facets of medical staff meetings, which includes scheduling, distributing notices, recording minutes, as appropriate. Participates in quality studies. Performs other duties, as assigned.

Requirements

• Associates degree AND 1 year of experience in a healthcare-related environment, preferably in Med Staff Credentialing;
• OR minimum 3 years of experience in a healthcare-related environment required, preferably in Med Staff Credentialing.
• Experience with credentialing accreditation by The Joint Commission and NCQA.
• Demonstrated working knowledge of healthcare and credentialing industry, including familiarity with Illinois and Wisconsin State laws, regulatory agencies, and other national standards preferred.
• Understanding of professional telephone and email correspondence etiquette.
• Able to work with minimal supervision and under pressure. Able to work well in an individual and group environment.
• Proactively prioritizes needs and displays effective time management. Shows attention to detail.
• Communicates clearly and concisely.
• Displays autonomous decision-making and critical thinking skills with a strong ability to problem-solve.
• Must have excellent interpersonal and written communication skills, including spelling, grammar and basic mathematical calculations.
• Establishes and maintains long-term customer relationships by building trust and respect.
• Articulates knowledge and understanding or organizational policies and procedures
• Demonstrates proficiency in Microsoft Office (Word, Excel and other applications, as required.
• Demonstrates knowledge of credentialing software; Credential Stream preferred.
• Maintains confidentiality of privileged information.
• Knowledge of accepted practices related to primary source verification.

Nice To Haves

• CPCS or CPMSM preferred.

Responsibilities

• Maintains high quality, timely and accurate credentialing processes of medical and allied healthcare professionals based upon system policies and procedures.
• Assists in the credentialing process by entering, logging, scanning information into the system for initial appointments, reappointments, add-on applications and maintenance.
• Completes and ensures compliance and delivery of required information to all customers in a timely manner.
• Processes and maintains credentialing and recredentialing in accordance with Mercy policies and procedures, Joint Commission and NCQA standards, and State and Federal regulatory guidelines.
• Ensures that all credentials are current and complete pursuant to expiration date of medical licensure, board certification, professional liability insurance coverage, DEA and other pertinent information per Mercy policy/procedure.
• Monitors collection of all information received. Follow-up on missing items/documentation/incomplete forms. Submits follow- up requests, as needed.
• Identifies and evaluates potential red flags and works in collaboration with practitioner(s) to document the issue and practitioner response.
• Advises team lead and/or manager of questionable information received and any issues identified during processes.
• Submits closed files for audit/final review and secures missing items as identified by audit/final review.
• Maintains all credentials files to ensure that all correspondence is accurately filed; is knowledgeable and current in regard to process and legal/regulatory requirements.
• Maintains compliance with Mercy policies/procedures, federal, state and all accrediting agencies as required.
• Responds to verification, case log, and proof of malpractice coverage requests from hospitals and managed care organizations.
• Works with agencies and practitioners to assemble credentials files and arranges for review and secures signatures for locum tenens privileges.
• Responsible for taking credentialing files through full approval process, from Credentials Committee to Medical Executive Committee, through the Board Action Report.
• Schedules and secures rooms for Medical Staff meetings, sends out notices, drafts agenda, assembles meeting materials, drafts minutes and follow-up correspondence.
• Maintains practitioner information in credentialing software platform

Benefits

• Comprehensive Benefits Package: Mercyhealth offers a retirement plan with competitive matching contribution, comprehensive medical, dental, and vision insurance options, life and disability coverage, access to flexible spending plans, and a variety of other discounted voluntary benefit options.
• Competitive Compensation: Mercyhealth offers market competitive rates of pay and participates in various shift differential and special pay incentive programs.
• Paid Time Off: Mercyhealth offers a generous paid time off plan, which increases with milestone anniversaries, to allow employees the opportunity for a great work-life balance.
• Career Advancement: Mercyhealth offers a number of educational assistance programs and career ladders to support employees in their educational journey and advancement within Mercyhealth.
• Employee Wellbeing: Mercyhealth has a focus on wellbeing for employees across the organization and offers a number of tools and resources, such as an employer-sponsored health risk assessment and a Wellbeing mobile application, to assist employees on their wellbeing journey.
• Additional Benefits: Mercyhealth employees have access to our internal and external employee assistance programs, employee-only discount packages, paid parental and caregiver leaves, on-demand pay, special payment programs for patient services, and financial education to help with retirement planning.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree