Credentialing Specialist – Professional Staff Office
Job Description
“If you require alternative methods of application or screening, you
Credentialing Specialist
Position Highlights:
- Position: Credentials Specialist
- Location: Skokie, IL
- Full Time/Part Time: Full Time
- Hours: Monday-Friday, 8:30 am – 5pm
- Required Travel: N/A
What you will do:
Initial Application Processing of Physicians and Advanced Practice Providers:
- Send out application packet and clinical privilege requests (as applicable) within 5 days of notice to potential applicants.
- Review application received for completeness and accuracy. Initiate verification of information, obtain NPBD query, license verification, education verification, AMA physician profile, DEA, malpractice insurance, criminal background check, health clearance, and board certification.
- Primary source verify application information. Query NPDB and enroll in continuous query. All current and past licensure, controlled substances, certification, boards, AMA Masterfile, DEA, malpractice carrier. Obtain criminal background check and health clearance.
- Review application and results from verification sources to identify any red flags. Provide this information to Manager/Director and Department Chairman.
- Review request for clinical privileges. Assure required documentation has been submitted if required and that request is appropriate and applicant has followed form directions. Follow up with applicant and hiring managers when necessary in case of APP’s.
- Investigate any possible errors, omissions, or irregularities presented. Run report to discover and seek resolution to any time gaps greater than 30 days in chronology. Follow up with applicant as needed, and inform manager if any issues are identified.
- Assemble data and send to the Department for Division Head and Chairman review and sign off.
- Scan all files completely in accordance with scanning policy with 100% accuracy for content and image resolution.
Reappointment of Physicians and Advanced Practice Providers:
- Follows reappointment timeline for each reappointment cycle, which are 2 per year, 6 months each in length.
- Review application received for completeness and accuracy. Update MSOW as required with new or revised demographic information. Upload or Scan in new/revised certificates, CV and other items as appropriate.
- Initiate primary source verification of information. Assures continuous query enrollment in NPDB, all active license verification, DEA, malpractice, board certification. Update images and profile in the MSOW software. Verifies web crawls are accurate and correct.
- Follow-up with provider and notify departments on those applications not returned on time, or that are incomplete.
- Document and prepare and send certified letters to those who have not returned their applications, as required by the Bylaws.
- Maintain Master Reappointment Grid
- Review application and results from verification sources to identify any red flags. Communicate red flags to Manager/Director and Department Chairman immediately.
- Load clinical privilege changes into MSOW e/Delineate and assure 100% accuracy via Pulse inquiry.
- Scan all files completely with 100% accuracy for content and image resolution.
- Prepare reappointment grid for sites and Committee approvals: Credentials Committee, Executive Committee and Board of Directors.
Data Quality and Reporting:
- Input data from application completely, accurately, and within department standards.
- Update profile information in the MSOW database of providers on an on-going basis as requested.
- Create Epic ID’s and troubleshoot issues with Epic Provider Master Team
- Assign appropriate facilities in MSOW per providers status (PST, MCC, employed, affiliate etc..)
- Support Academic Affairs staff when requested with House Staff Module needs and issues as they arise.
- Create reports in Crystal on data housed in the MSOW database.
- Process requests for data on physicians and APP’s.
- Provide reports on a monthly basis as requested by external agencies, and other NorthShore Departments.
Managed Care and Provider Enrollment:
- Process completed application, sending all necessary items to providers and plans for successful enrollment in health plans.
- Enroll providers in PECOS, under appropriate group(s) and TIN(s). Update providers NPI profile with appropriate demographics and taxonomy codes as necessary.
- Complete RFS to IS on all physicians who have been approved for Medicare/BCBS PPO/IDPA and Railroad as information is received, so billing can be facilitated accurately in Epic Resolute.
- Process applicants in IMPACT. Update master grid with enrollment information. Audit applicants to assure timely enrollment or follow up as necessary. Process provider enrollment sheets when received to complete enrollment.
- Investigate and solve enrollment related billing issues with the health plans, third party administrator, or Medicare Administrative Contractor as identified on the billing log, by revenue cycle team or by the practice managers relating to credentialing issues with payors.
- Follow up and complete all enrollments into plans within department timeframes.
- Scan all documents promptly once provider is enrolled, and processes completed per department policy.
Maintenance of Membership and Privilege Requests:
- Process requests for temporary privileges and one-case privileges as requested and approved by the department.
- Process requests for additional clinical privileges requested by providers and approved by the department.
- Process requests for change of status, category and clinical department.
- Process resignations and requests for leave of absence.
- Remove terminated providers from Continuous Query/NPDB.
- Support Disaster Privileging in the event of mass casualty and activation by CEO.
What you will need:
- Education: Bachelor’s Degree preferred
- Certification: NAMSS certification preferred
- Experience: 2 Years credentialing experience required
- Unique or Preferred Skills: Proficient in Microsoft Word and Excel. Credentialing data base management a plus. Excellent phone skills required. Ability to work well with others, especially physicians.
Benefits:
- Career Pathways to Promote Professional Growth and Development
- Various Medical, Dental, Pet and Vision options, including Domestic Partner Coverage
- 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
- Visa Sponsorship Available (Nursing and Lab roles)
NorthShore – Edward-Elmhurst 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. Located in Naperville, Linden Oaks Behavioral Health, provides for the mental health needs of area residents. For more information, visit
NorthShore.org
,
SwedishCovenant.org
,
NCH.org
and
EEHealth.org
.
When you work for NorthShore – Edward-Elmhurst 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.northshore.org
) to better understand how NorthShore – Edward-Elmhurst Health delivers on its mission to “help everyone in our communities be their best”.
NorthShore – Edward-Elmhurst 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.
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