Credentialing Coord Managed CR
Company: Mercy Health Corporation
Posted on: December 4, 2019
JOB REQUIREMENTS: Performs duties related to the Medical Staff
Office functions, which include but are not limited to
credentialing new and established healthcare providers, maintaining
information which includes primary source verification, follow-up,
data collection, data entry, and document review. Participates in
all facets of medical staff meetings, which includes scheduling,
distributing notices, recording minutes, as appropriate.
Participates in quality studies. Performs other duties, as
assigned. ESSENTIAL DUTIES AND RESPONSIBILITIES Maintains high
quality, timely and accurate credentialing processes of medical and
allied healthcare professionals based upon system policies and
procedures. Assists in the credentialing process by entering,
logging, scanning information into the system for initial
appointments, reappointments, add-on applications and maintenance.
Completes and ensures compliance and delivery of required
information to all customers in a timely manner. Processes and
maintains credentialing and recredentialing in accordance with
Mercy policies and procedures, Joint Commission standards, State
and Federal regulatory guidelines. Ensures that all credentials are
current and complete pursuant to expiration date of medical
licensure, board certification, professional liability insurance
coverage, DEA and other pertinent information per Mercy
policy/procedure. Monitors collection of all information received.
Follow-up on missing items/documentation/incomplete forms. Submits
follow-up requests, as needed. Identifies and evaluates potential
red flags and works in collaboration with practitioner(s) to
document the issue and practitioner response. Advises supervisor
and/or director of questionable information received and any issues
identified during processes. Submits closed files for audit/final
review and secures missing items as identified by audit/final
review. Maintains all credentials files to ensure that all
correspondence is accurately filed; is knowledgeable and current in
regard to process and legal/regulatory requirements. Maintains
compliance with Mercy policies/procedures, federal, state and all
accrediting agencies as required. Responds to verification requests
from hospitals and managed care organizations. Orders Medical Staff
Office supplies. Bills for Medical Staff dues. Works with agencies
and practitioners to assemble credentials files and arranges for
review and secures signatures for locum tenens privileges. Serves
as a resource for the Medical Staff on Medical Staff Bylaws issues.
Assists physicians in developing criteria for privileging.
Schedules and secures rooms for Medical Staff meetings, sends out
notices, drafts agenda, assembles meeting materials, drafts minutes
and follow-up correspondence. Maintains information in CACTUS
database. Produces labels and writes reports from database.
Maintains meeting attendance records in CACTUS database. Maintains
Mercy sponsored CME records in CACTUS database. EOE &
AA/M/F/Vet/Disabled. Mercy is an equal employment opportunity
employer functioning under Affirmative Action Plans. Equal
Opportunity/Affirmative Action Employer ***** OTHER EXPERIENCE AND
QUALIFICATIONS: EDUCATION & EXPERIENCE Associate's degree required.
A minimum of one-year experience in healthcare credentialing
(healthcare facility, managed care setting, CVO, or medical staff
office) strongly preferred. Or equivalent combination of education
and experience with Bachelor's degree strongly preferred.
CERTIFICATION/LICENSURE CPMSM or CPCS preferred or commitment to
pursue certification within two years. ADDITIONAL REQUIREMENTS
Passing the Driver's License Check and/or Credit Check (for those
positions requiring). Passing the WI Caregiver Background Check
and/or IL Health Care Workers Background Check. Must be able to
follow written/oral instructions. OTHER SKILLS AND ABILITIES
Experience with credentialing accreditation by The Joint Commission
or NCQA. Demonstrated worki g knowledge of healthcare and
credentialing industry, including medicolegal issues and laws,
regulatory agencies, and other national standards preferred.
Understanding of professional telephone etiquette. Able to work
with minimal supervision and under pressure. Able to work well in
individual and group environment. Proactively prioritizes needs.
Shows attention to detail. Communicates clearly and concisely. Must
have excellent interpersonal and written communication skills,
including spelling, grammar and basic mathematical calculations.
Establishes and maintains long-term customer relationships by
building trust and respect. ***** APPLICATION INSTRUCTIONS: Apply
Keywords: Mercy Health Corporation, Janesville , Credentialing Coord Managed CR, Other , Janesville, Wisconsin
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