Credentialing Specialist

Nevada System of Higher Education

87d • $24 - $37

About The Position

The Credentialing Specialist plays a critical role in ensuring that healthcare providers are properly credentialed, whether they are joining the medical staff of an Endeavor Health Hospital, seeking enrollment in government health plans, or requiring managed care credentialing and rostering. The Credentialing Specialist is responsible for processing applications, reappointments, and enrollment for over 7,000 providers across the Endeavor Health system. This includes those who wish to join a hospital medical staff, be enrolled in government health plans, belong to an IPA/PHO, or the Clinically Integrated Network (CIN). The specialist builds and maintains provider data profiles, which feed into enterprise-wide systems such as Workday, Data Warehouse, and Epic. Depending on their focus area, the specialist may either manage credentialing for the Central Verification Office (CVO), which serves the entire system, or support the Medical Staff Office (MSO) by executing the hospital credentialing process in accordance with Medical Staff Bylaws. In either role, the specialist collaborates with various teams to ensure compliance and accuracy in provider credentialing.

Requirements

• High School Diploma.
• Certified Provider Credentials Specialist (CPCS) through National Association Medical Staff Services (NAMSS) is preferred.
• Certification within 3 years of hire is required.
• Two years credentialing experience preferred.

Nice To Haves

• Ability to make administrative/procedural decisions and judgements.
• Ability to investigate and analyze information and draw conclusions.
• Ability to process computer data, format and generate reports.
• Ability to communicate effectively, both orally and in writing.
• Ability to foster a cooperative working environment.
• Ability to participate positively in a team environment.
• Ability to multitask, manage multiple priorities, customers, and deadlines.
• Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community.
• Knowledge of PECOS enrollment for Medicare.
• Knowledge of Medicare Railroad enrollment system under Palmetto GBA.
• Knowledge of IMPACT enrollment system for IL Medicaid.
• Knowledge of MSOW Credentialing Software and Reporting.
• Knowledge of standards and rules for ABMS Board Certification.
• Knowledge of related accreditation and regulatory certification requirements: TJC, CMS, DNV, ACHC.
• Knowledge of medical credentialing, provider privileging and standards.
• Knowledge of Bylaws, policies and regulations of Endeavor hospitals and legal environment in which they operate.

Responsibilities

• Initial and reappointment application processing utilizing credentialing software.
• Verifies application elements according to Endeavor health policies, regulatory standards (The Joint Commission (TJC), Centers for Medicare and Medicaid Services (CMS), state and federal laws and third party payor contracts).
• Critically reviews provider data and verification results to identify any red flags, privilege request issues, and any other application issues and communicates with key stakeholders (HR, hiring managers, practice managers, Chairman and Division Heads) to resolve prior to releasing to the site/requestor.
• Enroll, revalidate, and modify billing providers in government plans (Medicare/Medicaid) and input/update data as appropriate to assure successful enrollment and retention of providers for revenue cycle.
• Collaborate with network management to assure plan data is accurate and provider verification is sent to Endeavor Health physician partners for review and approval.
• Manages expirable process for all relevant licensure and insurance on all providers.
• Facilitates provider privileging criteria, privileging process and leadership sign off.
• Completes committee review, approvals, and board letters.
• Completes Administrative Review Manager processes.
• Completes and maintains correct data and images in MSOW on each provider - specific to each providers facility as well as relevant shared data elements across facilities to ensure files are up to date for data use and survey ready.
• Processes requests for change of status, privileges, and demographic updates as requested by providers.
• Facilitates for the appropriate leadership and committee approvals as well as approval letters, and system updates.
• Facilitates all necessary provider site orientations, onboarding and access to appropriate IT systems.
• Supports medical staff and department committees as assigned, completes agendas, minutes and meeting preparations as required.
• Responds to requests for verification of providers to external agencies in a timely manner.
• Supports Graduate Medical Education applicants and rotations.

Benefits

• Premium pay for eligible employees.
• Career Pathways to Promote Professional Growth and Development.
• Various Medical, Dental, Pet and Vision options.
• Tuition Reimbursement.
• Free Parking.
• Wellness Program.
• Savings Plan.
• Health Savings Account Options.
• Retirement Options with Company Match.
• Paid Time Off and Holiday Pay.
• Community Involvement Opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED