Credentialing Specialist - Clinical Staff Office

UIOWA•Iowa City, IA

2d•Onsite

About The Position

Under general supervision, the Credentialing Specialist performs hospital privileging, managed care credentialing, and verification activities by examining and evaluating data according to established guidelines. The work requires knowledge of rules, criteria, accreditation standards, and UI Health Care Bylaws, Rules & Regulations. These activities affect whether practitioners can provide patient care at UI Health Care, its outreach clinics, and for external clients and managed care payors. The Clinical Staff Office provides credentialing verification services for UI Health Care, Stead Family Children’s Hospital, outreach clinics, external clients, managed care payers, state agencies, colleges, and student health centers in and outside Iowa. The role involves obtaining and authenticating sensitive information and interpreting standards from accrediting bodies and UI Health Care policies. The successful candidate is highly organized, communicates effectively, has strong computer and customer service skills, works well with a team, and manages multiple priorities. The position requires sound problem-solving and critical decision-making, attention to deadlines, and a commitment to completing work accurately and professionally. The role supports daily credentialing operations and collaborates with clinical departments, supervisors, and Clinical Staff Office leadership. This is a full-time position at the Healthcare Support Services Building in Coralville, Iowa. The work schedule has some flexibility between 7:00 AM and 5:00 PM, Monday through Friday. Salary is at level 3A, with starting pay determined by qualifications and relevant experience. Applicants must provide a current resume and a cover letter addressing the required and desired qualifications. Employment authorization sponsorship is not available; successful candidates must disclose conviction history and undergo a criminal background check.

Requirements

BA or BS degree, or a combination of related education and experience.
1–3 years of experience in a regulatory environment requiring attention to detail.
Demonstrated proficiency in Microsoft Office Suite, including Outlook, Word, and Excel.
Demonstrated excellence in written and oral communication skills.
A successful record of managing multiple tasks, meeting deadlines, and completing tasks in full.

Nice To Haves

Working knowledge of medical terminology.
Knowledge of UI Health Care Bylaws, Rules & Regulations.
Knowledge of Joint Commission (JC) and National Committee for Quality Assurance (NCQA) standards.

Responsibilities

Examine, evaluate, and verify documents for completeness, accuracy, and conformity with established guidelines and policies.
Follow up on discrepancies and resolve problems; maintain appropriate files.
Investigate and analyze data for accuracy while adhering to accrediting and regulatory compliance standards, including Joint Commission, NCQA, and URAC standards.
Prepare privileging packets for supervisors to review before committee submission.
Track and analyze credentialing applications and materials in coordination with clinical department HR representatives.
Identify and follow up on primary source verifications and obtain contact information for primary sources.
Enter, analyze, and maintain data in a complex database, and generate reports.
Support daily credentialing operations in the office and clinical departments, coordinate processes with colleagues, respond to routine and complex inquiries, and resolve issues involving missing, questionable, or incomplete information to meet deadlines.
Maintain working knowledge of UI Health Care Bylaws and credentialing and CSO policies and procedures, applying that knowledge to individual practitioners’ credentialing and privileging activities.
Initiate and process standardized forms related to the assigned area.
Conduct weekly interim and ongoing monitoring of practitioner licenses, controlled substance certificates, insurance certificates, board certifications, CPR, and other state and federal agency requirements.
Participate in weekly supervisor meetings to review files and workload and resolve file issues.
Participate in monthly Quality Improvement meetings, contribute to process improvement and policy development or revision, and suggest improvements as issues arise.
Educate department contacts regularly about Joint Commission and NCQA standards and UI Health Care credentialing and privileging policies and procedures.
Support Clinical Staff Office leadership, including the Chief Medical Officer, CSO Director, and Credentialing Supervisors.
Perform other duties as assigned.