Credentialing Specialist - Warrenville, IL - FT
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Initiate, verify, examine, and maintain the confidential credentials process for all professional applicants to NM (physicians, dentists, psychologists, advanced practice nurses, physician assistants, and designated clinical fellows). Ensure compliance with all regulatory and NM established criteria that the applicant is able to practice in the state of Illinois and at NM affiliates and that current, verified documentation is on file (licenses[s], malpractice liability insurance, board certification, NUFSM faculty appointment). Examine application for completeness and all required documentation. Examine information reported for missing data elements, timelines and time gaps. Identify as acceptable or adverse. Conduct follow-up with applicant on identified adverse elements. Investigate as necessary through to final resolution. Perform primary source verification of all required credentials data elements and direct inquiries to all required data banks, profiling providers, licensing/regulatory agencies, etc. in compliance with all accreditation, federal, state and NM requirements. Examine and evaluate credentials information and results obtained by cross-referencing and comparing to information reported on application and curriculum vitae. Identify as acceptable or adverse. Examine for compliance with NM medical staff qualifications and criteria. Investigate discrepancies and misstatements with applicant and other primary sources as necessary through to final resolution. Identify key issues in core credentials data. Report identified adverse information and unresolved questions to credentials compliance coordinator. Identify all practice locations for each applicant for his/her lifetime work history and obtain malpractice litigation history from the appropriate district or county court. Examine history obtained and compare to malpractice litigation history reported by applicant. Identify as acceptable or adverse. Prepare report, identifying discrepancies if any, for review by the credentials compliance coordinator and associate general counsel. Determine when investigation and credentials process is complete by comparing and contrasting file to requirements and verifying that all documentation meets standards. Identify and flag time-sensitive items for reverification. Generate profile and reports. Submit recommendation for final follow-up to the lead credentialing specialist and/or manager prior to administrative review process. Maintain accurate and current credentials database for all applicants. Record all credentials information immediately upon receipt. Monitor and track application status and credentials process. At all times, any department staff member must be able to access an applicants electronic record and determine current status. Provide first contact and customer service to professional applicants and NU/NMG credentialing staff. Communicate regularly to appraise of application status and/or any missing items. Generate profile of credentials and provide documentation per requirements to other NM affiliates (NHC) to which the applicant is applying. Function as liaison for managed care credentialing for initial applicants. Assist the credentials compliance coordinator in the reappraisal/renewal credentials process. Perform all essential functions (#s 2-6 having potential for high-risk exposure for the hospital) in compliance with all accreditation standards (JCAHO, NCQA), federal and state laws and regulations (IDFPR, IDPH, NPDB, etc.) and NM/medical staff bylaws and policies/procedures. Maintain knowledge base as applicable to credentialing. Additional Functions, Provide support at meetings. AA/EOE
2 years college coursework in related area of study.
3 years in credentialing.
Certified Provider Credentialing Specialist. National Association Medical Staff Services.
Detail-oriented, organized, good judgment, self-motivated, ability to multi-task and work independently.
Database management (Access) and Microsoft Office.
Excellent interpersonal, customer service, and communication skills (oral and written).
Develop and maintain effective working relationships with diverse professionals, medical staff officers, department staffs, and other customers.
Work in a fast-paced environment, meet ongoing schedules and deadlines.
Recognize and maturely handle a variety of situations, often of a confidential or urgent nature.
3-5 years credentialing experience.
Experience in a university-affiliated teaching hospital.