Credentialing Coordinator

Mercyhealth Wisconsin and Illinois•Rockford, IL

5d•$21 - $35•Onsite

About The Position

Detail-oriented credentialing specialist with experience managing provider credentialing and recredentialing while ensuring compliance with regulatory and accreditation standards. Skilled in maintaining accurate provider records, coordinating with stakeholders, and delivering timely, high-quality administrative support in fast-paced healthcare environments.

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.
Familiarity with Illinois and Wisconsin State laws, regulatory agencies, and other national standards preferred.
Credential Stream 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