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USD
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47.00
HOUR
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Credentialing and Verification Specialist
Springfield, IL 62781 US | Fully Remote TELECOMMUTE US
Posted: 03/29/2024
2024-03-29
2024-05-15
Job Type:
Contract
Industry: Other (HR, Admin, Mkt, Sales)
Job Number: 25034
Pay Rate: $ 42.00 - $ 47.00
Job Description
Our client, one of the leading healthcare organizations in Illinois, is a community-based, not-for-profit organization that provides a full range of inpatient, outpatient, home health, hospice, behavioral health, and primary care physician services. With eight affiliates they deliver high-quality, patient-centered care in support of our mission to improve lives and build stronger communities through better health.
Our client is looking for a Credentialing and Verification Specialist to work with their CVO.
Remote position - May be required to come onsite for training if does not hold Medical Services Management (CPMSM) and/or Provider Credentialing Specialist (CPCS) certification.
The contract is for 3 months with the possibility of being extended or converted to a Direct Hire.
Equipment will be provided.
Position Summary:
- Assist the System Director, Credentialing and Medical Staff Services, in the credentialing and verification upon initial application and reapplication to staff.
- Works with their leader to improve the credentialing and verification process, streamline hospital privileging and support managed care credentialing.
- Embodies the System Performance Excellence Standards of Safety, Courtesy, Quality, and Efficiency that support our mission, vision and values.
Principle Duties & Responsibilities:
1. Responsible for credentialing Medical Staff initial applicants and reapplicants to our Health Hospitals under the oversight of the System Director, Credentialing and Medical Staff Services.
2. Supports our Health Managed Care with their provider credentialing for internal and external managed care credentialing needs under the oversight of the System Director, Credentialing, and Medical Staff Services.
3. Overseas the practitioner credentialing database ensuring accurate and current information is available to all stakeholders.
4. Participates in the development and implementation of credentialing processes and procedures.
5. Audits, assesses, procures, implements, effectively utilizes and maintains practitioner/provider credentialing processes and information systems (e.g., files, reports, minutes, databases) by analyzing the needs and resources of medical services/credentialing.
6. Supports our affiliate hospital Medical Staff Offices in the privileging process.
7. Ensures that policies, procedures, and mechanisms to support the credentialing process in accordance with Medical Staff Bylaws, Rules and Regulations and in compliance with standards of all external regulatory and accrediting bodies.
8. Provide administrative support required to ensure effective management and coordination of the medical/allied health professional staff credentialing processes.
9. Embodies the Health System Performance Excellence Standards of Safety, Courtesy, Quality, and Efficiency that support our mission, vision, and values:
1. Responsible for credentialing Medical Staff initial applicants and reapplicants to our Health Hospitals under the oversight of the System Director, Credentialing and Medical Staff Services.
2. Supports our Health Managed Care with their provider credentialing for internal and external managed care credentialing needs under the oversight of the System Director, Credentialing, and Medical Staff Services.
3. Overseas the practitioner credentialing database ensuring accurate and current information is available to all stakeholders.
4. Participates in the development and implementation of credentialing processes and procedures.
5. Audits, assesses, procures, implements, effectively utilizes and maintains practitioner/provider credentialing processes and information systems (e.g., files, reports, minutes, databases) by analyzing the needs and resources of medical services/credentialing.
6. Supports our affiliate hospital Medical Staff Offices in the privileging process.
7. Ensures that policies, procedures, and mechanisms to support the credentialing process in accordance with Medical Staff Bylaws, Rules and Regulations and in compliance with standards of all external regulatory and accrediting bodies.
8. Provide administrative support required to ensure effective management and coordination of the medical/allied health professional staff credentialing processes.
9. Embodies the Health System Performance Excellence Standards of Safety, Courtesy, Quality, and Efficiency that support our mission, vision, and values:
10. Assist the System Director, Credentialing, and Medical Staff Services in the management of data to support the peer review process.
11. Maintain cooperative and supporting working relationships with all individuals who have involvement with organized the Credentialing and Verification Office.
11. Maintain cooperative and supporting working relationships with all individuals who have involvement with organized the Credentialing and Verification Office.
Job Requirements
Must Have:
- MD-Staff - Credentialing Software Experience
- Hospital Credentialing Experience
- Years of Experience: 3 years min, ideally 5+ years
- Working knowledge of medical terminology
- Excellent verbal and communication skills
Nice to have:
- Certification: Medical Services Management (CPMSM) and/or Provider Credentialing Specialist (CPCS) certifications or the equivalent of 3 years of experience
Minimum Qualifications:
- Education:
- Bachelor's degree in business or health related field is desirable.
- Licensure/Certification/Registry:
- Successful completion and ongoing maintenance of the Medical Services Management (CPMSM) and/or Provider Credentialing Specialist (CPCS) certifications.
- Experience:
- A minimum of 3-5 years experience in medical staff services
- Proven experience in maintaining collegial working relationships with physicians, allied health professionals and members of the leadership team.
- Other Knowledge/Skills/Abilities:
- Working knowledge of medical terminology is required.
* Excellent verbal and communication skills are required.
* Proven team player.
- Working knowledge of medical terminology is required.
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