Credentialing Coordinator 1

Essential Duties and 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

Culture of Excellence Behavior Expectations

To perform the job successfully, an individual should demonstrate the following behavior expectations:

Quality - Follows policies and procedures; adapts to and manages changes in the environment; Demonstrates accuracy and thoroughness giving attention to details; Looks for ways to improve and promote quality; Applies feedback to improve performance; Manages time and prioritizes effectively to achieve organizational goals.

Service - Responds promptly to requests for service and assistance; Follows the Mercyhealth Critical Moments of service; Meets commitments; Abides by MH confidentiality and security agreement; Shows respect and sensitivity for cultural differences; and effectively communicates information to partners; Thinks system wide regarding processes and functions.

Partnering - Shows commitment to the Mission of Mercyhealth and Culture of Excellence through all words and actions; Exhibits objectivity and openness to other's views; Demonstrates a high level of participation and engagement in day-to-day work; Gives and welcomes feedback; Generates suggestions for improving work: Embraces teamwork, supports and encourages positive change while giving value to individuals.

Cost - Conserves organization resources; Understands fiscal responsibility; Works within approved budget; Develops and implements cost saving measures; contributes to profits and revenue.

Education and Experience

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.

Certification and Licensure

CPCS or CPMSM preferred.

Skills and Abilities

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.

Special Physical Demands

The Special Physical Demands are considered Essential Job Functions of the position with or without reasonable accommodations.
In order to perform the demands of this job, the employee may sit for long periods, exerting up to 10 pounds of force occasionally, walking and standing occasionally. The employee is required to frequently reach with hands and arms, finger, handle, talk and hear. Manual dexterity is required.

Level of Supervision

Some independent judgement is required, but alternatives are limited by standard practices and procedures.

Supervises

None.

PAY RANGE:

Mercyhealth is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identify, national origin, disability, or protected veteran status.

Mercyhealth offers competitive pay and a comprehensive benefits package including:

• 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

Click here for more details regarding Mercyhealth Careers Benefit Information.

At Mercyhealth, we don't simply hire people, we empower employee-partners who are passionate about making lives better. As an integrated health system, we deliver exceptional, coordinated across seven hospitals, 85 primary and specialty clinics, and a team of over 7,500 professionals serving northern Illinois and southern Wisconsin.

Mercyhealth has been nationally recognized for our commitment to our people and culture, including:

• #1 in the nation on AARP's Best Employers for Workers Over 50

• One of Working Mother magazine's 100 Best Companies for Working Mothers

• A Top 50 Company and Top 10 Nonprofit for Executive Women