Lead Credentialing Specialist

Fairview Health Services • Minneapolis, MN

17h

About The Position

Fairview is looking for a Lead Credentialing Coordinator to join our team. The Lead Credentialing Coordinator works with team members and practitioners applying for credentialing at any Fairview location to ensure timely and smooth completion of processes that meet Joint Commission (JC) and/or National Committee for Quality Assurance (NCQA) standards. Assists and works with team members to address questions regarding processing of files, problem solving, identifies and assists with opportunities for improvement in credentialing processes, and develop new processes. Processes identified red flagged issues. Completes quality reviews of applications after processes have been completed. Utilizes statistics and quality review reports to develop, maintain, and facilitate education and on-going training materials and resources. Ensures all training materials and processes meet JC and NCQA standards. Conducts basic and advanced job skills training to ensure consistency and achieve the highest standards of customer service and quality. Facilitates the processes for practitioner Leave of Absences, verifications of non-standard hospital affiliation requests. Prepares notification reports for practitioner license and/or other reportable actions. Assists in assigning work to team members and with department's performance improvement processes and implementation of changes, and maintaining process guides. Completes special projects as assigned.

Requirements

• A.A./A.S. Associate degree or two years of credentialing related experience.
• 1 year credentialing, payer enrollment, healthcare or administrative experience

Nice To Haves

• B.S./B.A. Bachelor's degree in Business or Health Care related field, including Medical Terminology.
• 2 years credentialing, payer enrollment, healthcare or administrative experience
• 3 years hospital credentialing experience
• CPCS or CPMSM certification

Responsibilities

• Assists team members on processing applications; problem solves issues and team questions.
• Identifies opportunities for improvements in credentialing processes; works with team members to develop new processes.
• Provides training to new employees and ongoing training and development to employees.
• Ensures sources for primary source verifications such as NPDB, AMA, ABMS, ECFMG, etc are current and meet JC and NCQA standards. Researches new primary verification sources as requested.
• Assists in maintaining department databases, associated files and records on a regular basis according to policies.
• Maintains general knowledge of credentialing policies and procedures, JC and NCQA accreditation standards, and credentialing policies for all Fairview faciliites.
• Assures confidentiality of all data is maintained.

Benefits

• Fairview offers a generous benefit package including but not limited to medical, dental, vision plans, life insurance, short-term and long-term disability insurance, PTO and Sick and Safe Time, tuition reimbursement, retirement, early access to earned wages, and more!
• Please follow this link foradditional information: https://www.fairview.org/careers/benefits/noncontract

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree