Credentialing Specialist (Hybrid)
About The Position
The Credentialing Specialist independently manages credentialing and privileging applications for practitioners and other credentialed staff. The role includes investigating and validating credential information, identifying potential discrepancies or adverse information, and escalating discrepancies and risks to the appropriate level before information reaches decision-making stakeholders. The specialist applies current state and regulatory standards and seeks resources to keep that knowledge up to date. The specialist manages primary source verification for initial and recredentialing and privileging processes, serves as a point of contact for applicants, maintains credentialing data, prepares profiles for review by senior provider leaders and decision-making bodies, and communicates process status to internal and external stakeholders. The role is based at Erie West Town Administrative Offices in Chicago, Illinois, with a hybrid designation in the job title.
Requirements
- High school diploma or equivalent.
- Two years of current work experience in credentialing.
- Basic computer skills, including Microsoft Office and credentialing software and databases.
- Ability to work independently without constant oversight, set work priorities, and determine goals and strategies to achieve them.
- Cultural competency to work with a diverse practitioner population.
- Ability to communicate effectively verbally and in writing with practitioners, hiring managers, and senior provider leaders at various levels.
- Ability to apply knowledge, expertise, sound judgment, and other resources to generate and evaluate solutions and recommendations.
- Ability to consistently apply state, federal, and accrediting standards for credentialing and privileging.
- Ability to understand clinical competence in relation to privileging criteria and tools and techniques used to demonstrate competence.
- Ability to adapt behavior in response to new information, changing circumstances, and performance-improvement concepts.
Nice To Haves
- Certified Professional Credentialing Specialist certification from the National Association of Medical Staff Services.
- Bachelor’s degree.
- Experience applying privileging criteria.
- Intermediate proficiency in Microsoft Office.
- Advanced credentialing software and database skills.
Responsibilities
- Apply defined credentialing and privileging processes uniformly and manage primary source verification for initial and recredentialing and privileging processes for licensed practitioner providers and staff, including education, training, licensure, and peer references, within required regulatory, accrediting-body, and payer-plan timelines.
- Serve as a main point of contact for credentialed providers and staff during initial and recredentialing and privileging processes, providing timely updates and requested information.
- Independently investigate and validate credential information, applications, and primary source verifications.
- Accurately maintain practitioner provider and staff data.
- Prepare checklist profiles presenting practitioner-specific data, findings, and actions for review by senior provider leaders and decision-making bodies such as the Board Quality Improvement Committee.
- Verify the status of credentialed practitioner providers’ and staff members’ expirable credentials, such as licenses and certifications, and initiate verification sources to ensure compliance with internal and external requirements.
- Serve as a resource and communicate with Credentialing Department leadership, other Erie departments and teams, and external business partners about applicants’ credentialing status to ensure information flows to key stakeholders.
- Escalate discrepancies and risks to the appropriate level before information is presented to decision-making stakeholders.
Benefits
- Medical, dental, vision, life, and disability insurance.
- Flexible Spending Account for health care or childcare.
- 401(k) program with employer matching of $0.50 for every $1.00 contributed, up to the first 5% of the employee’s biweekly salary.
- Annual paid time off starting at 20 days.
- Eight paid holidays.
- Annual merit increases.
- Room for growth and career advancement.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
