Credentialing Coordinator Jobs

About The Position

Requirements

• Associates degree AND 1 year of experience in a healthcare-related environment, preferably in Med Staff Credentialing; OR minimum 3 years of experience in a healthcare-related environment required, preferably in Med Staff Credentialing.
• Experience with credentialing accreditation by The Joint Commission and NCQA.
• Demonstrated working knowledge of healthcare and credentialing industry, including familiarity with Illinois and Wisconsin State laws, regulatory agencies, and other national standards preferred.
• Understanding of professional telephone and email correspondence etiquette.
• Able to work with minimal supervision and under pressure.
• Able to work well in an individual and group environment.
• Proactively prioritizes needs and displays effective time management.
• Shows attention to detail.
• Communicates clearly and concisely.
• Displays autonomous decision-making and critical thinking skills with a strong ability to problem-solve.
• Must have excellent interpersonal and written communication skills, including spelling, grammar and basic mathematical calculations.
• Establishes and maintains long-term customer relationships by building trust and respect.
• Articulates knowledge and understanding or organizational policies and procedures
• Demonstrates proficiency in Microsoft Office (Word, Excel and other applications, as required.
• Demonstrates knowledge of credentialing software; Credential Stream preferred.
• Maintains confidentiality of privileged information.
• Knowledge of accepted practices related to primary source verification.

Nice To Haves

• CPCS or CPMSM preferred.
• Familiarity with Illinois and Wisconsin State laws, regulatory agencies, and other national standards preferred.
• Credential Stream preferred.

Responsibilities

• Maintains high quality, timely and accurate credentialing processes of medical and allied healthcare professionals based upon system policies and procedures.
• Assists in the credentialing process by entering, logging, scanning information into the system for initial appointments, reappointments, add-on applications and maintenance.
• Completes and ensures compliance and delivery of required information to all customers in a timely manner.
• Processes and maintains credentialing and recredentialing in accordance with Mercy policies and procedures, Joint Commission and NCQA standards, and State and Federal regulatory guidelines.
• Ensures that all credentials are current and complete pursuant to expiration date of medical licensure, board certification, professional liability insurance coverage, DEA and other pertinent information per Mercy policy/procedure.
• Monitors collection of all information received. Follow-up on missing items/documentation/incomplete forms. Submits follow- up requests, as needed.
• Identifies and evaluates potential red flags and works in collaboration with practitioner(s) to document the issue and practitioner response.
• Advises team lead and/or manager of questionable information received and any issues identified during processes.
• Submits closed files for audit/final review and secures missing items as identified by audit/final review.
• Maintains all credentials files to ensure that all correspondence is accurately filed; is knowledgeable and current in regard to process and legal/regulatory requirements.
• Maintains compliance with Mercy policies/procedures, federal, state and all accrediting agencies as required.
• Responds to verification, case log, and proof of malpractice coverage requests from hospitals and managed care organizations.
• Works with agencies and practitioners to assemble credentials files and arranges for review and secures signatures for locum tenens privileges.
• Responsible for taking credentialing files through full approval process, from Credentials Committee to Medical Executive Committee, through the Board Action Report.
• Schedules and secures rooms for Medical Staff meetings, sends out notices, drafts agenda, assembles meeting materials, drafts minutes and follow-up correspondence.
• Maintains practitioner information in credentialing software platform

Benefits

• Medical, Dental, Vision
• Life & Disability Insurance
• FSA/HSA Options
• Generous, accruing paid time off
• Paid Parental and caregiver leave
• Career advancement and educational opportunities
• Tuition and certification reimbursement
• Certification Reimbursement
• Well-being Programs
• Employee Discounts
• On-Demand Pay
• Financial Education
• Annual recognition/awards events
• Partner appreciation days
• Family entertainment/attractions discount
• Community service/improvement opportunities