Credentialing Coord Managed CR

Company: Mercy Health Corporation
Location: Janesville
Posted on: December 4, 2019

Job Description:

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 Online: *************************

Keywords: Mercy Health Corporation, Janesville , Credentialing Coord Managed CR, Other , Janesville, Wisconsin