Credentialing Specialist

Swh Swedish Hospital Chicagomid

OtherCredentialing Specialist

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Quick Summary

Key Responsibilities

Processes initial and reappointment applications g utilizing credentialing software, verifies application elements according to Endeavor health policies, regulatory standards (TJC, CMS..),

Requirements Summary

TJC, CMS, DNV, ACHC Knowledge of medical credentialing, provider privileging and standards. Knowledge of Bylaws,

Technical Tools

OtherCredentialing Specialist

$25.36 - $38.04 - The hourly pay rate offered is determined by a candidate's expertise and years of experience, among other factors.

Position: Credentialing Specialist
Location: Chicago, IL
Full Time: 40 hours per week
Hours: Monday-Friday, 7:30a-4:30p

Responsibilities

~2 min read

→Processes initial and reappointment applications g 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 (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.
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→High School Required
→2 Years credentialing experience preferred.
→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.
→Certified Provider Credentials Specialist (CPCS) thru National Association Medical Staff Services (NAMSS) Required