Credentialing Specialist

Credentialing Specialist

Position Highlights:

• Position: Credentialing Specialist
• Hourly Pay Range: $24.86 - $37.29 The hourly pay rate offered is determined by a candidate's expertise and years of experience, among other factors.
• Location: Arlington Heights, IL
• Full Time/Part Time: Full time
• Hours: Monday-Friday, 7:30am - 4:30pm
• Required Travel: no

Job Summary:

The Credentialing Specialist plays a critical role in ensuring that healthcare providers are properly credentialed, whether they are joining the medical staff of an Endeavor Health Hospital, seeking enrollment in government health plans, or requiring managed care credentialing and rostering. The Credentialing Specialist is responsible for processing applications, reappointments, and enrollment for over 7,000 providers across the Endeavor Health system. This includes those who wish to join a hospital medical staff, be enrolled in government health plans, belong to an IPA/PHO, or the Clinically Integrated Network (CIN). The specialist builds and maintains provider data profiles, which feed into enterprise-wide systems such as Workday, Data Warehouse, and Epic. Depending on their focus area, the specialist may either manage credentialing for the Central Verification Office (CVO), which serves the entire system, or support the Medical Staff Office (MSO) by executing the hospital credentialing process in accordance with Medical Staff Bylaws. In either role, the specialist collaborates with various teams to ensure compliance and accuracy in provider credentialing.

What you will do:

• Initial and reappointment application processing utilizing credentialing software, verifies application elements according to Endeavor health policies, regulatory standards (The Joint Commission (TJC), Centers for Medicare and Medicaid Services (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.
• Manages expirable process for all relevant licensure and insurance on all providers.
• For initial and reappointment, critically reviews applicant information to ensure it meets membership requirements, privilege criteria, hospital policy, all other medical staff governance requirements. Facilitates provider privileging criteria, privileging process and leadership sign off. Completes committee review, approvals, and board letters. Completes Administrative Review Manager processes.
• Completes and maintains correct data and images in MSOW on each provider - specific to each providers facility as well as relevant shared data elements across facilities to ensure files are up to date for data use and survey ready.
• Processes requests for change of status, privileges, and demographic updates as requested by providers. Facilitates for the appropriate leadership and committee approvals as well as approval letters, and system updates.
• Facilitates all necessary provider site orientations, onboarding and access to appropriate IT systems.
• Supports medical staff and department committees as assigned, completes agendas, minutes and meeting preparations as required.
• Responds to requests for verification of providers to external agencies in a timely manner.
• Supports Graduate Medical Education applicants and rotations. (site specific)

What you will need:

• Education: High School Diploma
• Certification: Certified Provider Credentials Specialist (CPCS) through National Association Medical Staff Services (NAMSS) is preferred. Certification within 3 years of hire is required
• Experience: Two years credentialing experience preferred.
• Unique or Preferred Skills:

• 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.

Environment

• Sit for long periods at dual monitor computer workstation using keyboard and mouse.
• Operate fax, printer, scanner, and telephone.
• Work in a fast paced, high stress environment with multiple deadlines and priorities.

Benefits (For full time or part time positions):

• Premium pay for eligible employees
• Career Pathways to Promote Professional Growth and Development
• Various Medical, Dental, Pet and Vision options
• Tuition Reimbursement
• Free Parking
• Wellness Program Savings Plan
• Health Savings Account Options
• Retirement Options with Company Match
• Paid Time Off and Holiday Pay
• Community Involvement Opportunities

Endeavor Health is a fully integrated healthcare delivery system committed to providing access to quality, vibrant, community-connected care, serving an area of more than 4.2 million residents across six northeast Illinois counties. Our more than 25,000 team members and more than 6,000 physicians aim to deliver transformative patient experiences and expert care close to home across more than 300 ambulatory locations and eight acute care hospitals - Edward (Naperville), Elmhurst, Evanston, Glenbrook (Glenview), Highland Park, Northwest Community (Arlington Heights) Skokie and Swedish (Chicago) - all recognized as Magnet hospitals for nursing excellence. For more information, visit www.endeavorhealth.org.

When you work for Endeavor Health, you will be part of an organization that encourages its employees to achieve career goals and maximize their professional potential.

Please explore our website (www.endeavorhealth.org) to better understand how Endeavor Health delivers on its mission to "help everyone in our communities be their best".

Endeavor Health is committed to working with and providing reasonable accommodation to individuals with disabilities. Please refer to the main career page for more information.

Diversity, equity and inclusion is at the core of who we are; being there for our patients and each other with compassion, respect and empathy. We believe that our strength resides in our differences and in connecting our best to provide community-connected healthcare for all.

EOE: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor.