Credentialing Specialist, Lead
NorthShore University HealthSystem, Naperville, Illinois, United States, 60564
Hourly Pay Range
$28.47 - $42.71 - The hourly pay rate offered is determined by a candidate's expertise and years of experience, among other factors.
Position Highlights
Position:
Lead Credentialing Specialist
Location:
Naperville, IL
Full Time:
40 hours
Hours:
Monday-Friday, 7:30a-4:00p
Required Travel:
To other Endeavor Locations
A Brief Overview The Credentials Specialist Lead provides training, coaching and support to the credentialing team of the CVO. Manages daily activities related to application and reappointment assignment, resolution of application issues with team and is the first line of problem resolution with complex issue management related to applications. Serves as a subject matter expert on Medicare Provider Enrollment, Chain, and Ownership System (PECOS), Illinois Medicaid Program Advanced Cloud Technology (IMPACT) and enrollment problem solving. Supports team with navigating MSOW system issues, compliance and policy questions related to sites, and managed care entities. This role also functions fully as a Credentials Specialist that processes applications and enrollment for 7000+ providers who request to be part of one or all the following: a hospital medical staff, be enrolled in a government health plans, belong to and IPA/PHO or to the Clinically Integrated Network (CIN) and require managed care credentialing and rostering to our contracted health plans. The specialist also processes reappointments for each provider which are processed every three years, and revalidation for CMS. Builds and maintains each provider's data profile, which feeds other enterprise-wide systems such as Workday, Data Warehouse and Epic. The CVO serves the entire system, and processes physicians, advanced practice professionals and other allied health professionals who are allowed to bill under state law and payor contracts.
What you will do
Trains, coaches, and supports the credentialing team while collaborating with the manager to develop and implement staff procedures, ensuring their consistent adoption and execution across the team.
Assigns applications and reappointments daily to team, resolves issues with requestors/customers.
Collaborates with the MSOW system administrator to test and optimize system processes and performance, troubleshooting alongside the technical support team to ensure seamless functionality aligns with credentialing workflows.
Initial and reappointment application processing utilizing credentialing software, verifies application elements according to Endeavor health policies, regulatory standards (TJC, 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 (PECOS/IMPACT) 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 the organization's physician partners for review and approval.
What you will need
High School Required
4 Years Credentialing experience preferred.
Ability to teach, and coach team members.
Ability to be objective and diplomatic with team to problem solve.
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 provider enrollment for Medicare.
Knowledge of facility enrollment for Medicare (done by leads only).
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.
Certified Provider Credentialing Specialist (CPCS) - National Association Medical Staff Services (NAMSS) Required
Benefits (for full and part time positions)
Premium pay for eligible employees
Career Pathways to Promote Professional Growth and Development
Various Medical, Dental, and Vision options
Tuition Reimbursement
Free Parking at designated locations
Wellness Program Savings Plan
Health Savings Account Options
Retirement Options with Company Match
Paid Time Off
Community Involvement Opportunities
EOE: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor.
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Position Highlights
Position:
Lead Credentialing Specialist
Location:
Naperville, IL
Full Time:
40 hours
Hours:
Monday-Friday, 7:30a-4:00p
Required Travel:
To other Endeavor Locations
A Brief Overview The Credentials Specialist Lead provides training, coaching and support to the credentialing team of the CVO. Manages daily activities related to application and reappointment assignment, resolution of application issues with team and is the first line of problem resolution with complex issue management related to applications. Serves as a subject matter expert on Medicare Provider Enrollment, Chain, and Ownership System (PECOS), Illinois Medicaid Program Advanced Cloud Technology (IMPACT) and enrollment problem solving. Supports team with navigating MSOW system issues, compliance and policy questions related to sites, and managed care entities. This role also functions fully as a Credentials Specialist that processes applications and enrollment for 7000+ providers who request to be part of one or all the following: a hospital medical staff, be enrolled in a government health plans, belong to and IPA/PHO or to the Clinically Integrated Network (CIN) and require managed care credentialing and rostering to our contracted health plans. The specialist also processes reappointments for each provider which are processed every three years, and revalidation for CMS. Builds and maintains each provider's data profile, which feeds other enterprise-wide systems such as Workday, Data Warehouse and Epic. The CVO serves the entire system, and processes physicians, advanced practice professionals and other allied health professionals who are allowed to bill under state law and payor contracts.
What you will do
Trains, coaches, and supports the credentialing team while collaborating with the manager to develop and implement staff procedures, ensuring their consistent adoption and execution across the team.
Assigns applications and reappointments daily to team, resolves issues with requestors/customers.
Collaborates with the MSOW system administrator to test and optimize system processes and performance, troubleshooting alongside the technical support team to ensure seamless functionality aligns with credentialing workflows.
Initial and reappointment application processing utilizing credentialing software, verifies application elements according to Endeavor health policies, regulatory standards (TJC, 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 (PECOS/IMPACT) 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 the organization's physician partners for review and approval.
What you will need
High School Required
4 Years Credentialing experience preferred.
Ability to teach, and coach team members.
Ability to be objective and diplomatic with team to problem solve.
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 provider enrollment for Medicare.
Knowledge of facility enrollment for Medicare (done by leads only).
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.
Certified Provider Credentialing Specialist (CPCS) - National Association Medical Staff Services (NAMSS) Required
Benefits (for full and part time positions)
Premium pay for eligible employees
Career Pathways to Promote Professional Growth and Development
Various Medical, Dental, and Vision options
Tuition Reimbursement
Free Parking at designated locations
Wellness Program Savings Plan
Health Savings Account Options
Retirement Options with Company Match
Paid Time Off
Community Involvement Opportunities
EOE: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor.
#J-18808-Ljbffr