Credentialing Specialist

Endeavor Health•Chicago, IL

39d•$25 - $38•Onsite

About The Position

The Central Verification Office (CVO) Credentials Specialist processes applications and enrollment for 7000+ providers who request to be part of one or all of the following: a hospital medical staff, be enrolled in a government health plans, belong to and IPA/PHO or to the Clinically Integrated Network (CIN) are require managed care credentialing and rostering to our contracted health plans. The specialist also processes reappointments for each provider which are processed every three years, and revalidation for CMS. Builds and maintains each provider's data profile, which feeds other enterprise-wide systems such as Workday, Data Warehouse and Epic. The CVO serves the entire Endeavor system, and processes physicians, advanced practice professionals and other allied health professionals who are allowed to bill under state law and payor contracts.

Requirements

High School Required
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 priories, 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.
Certified Provider Credentials Specialist (CPCS) thru National Association Medical Staff Services (NAMSS) Required

Nice To Haves

2 Years credentialing experience preferred.

Responsibilities

Processes initial and reappointment applications g utilizing credentialing software, verifies application elements according to Endeavor health policies, regulatory standards (TJC, 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.