Credentialing Specialist

About This Role

Processing applications and enrollment for over 7,000 healthcare providers is the main purpose of this credentialing specialist role. It involves managing initial applications, reappointments, and revalidations, and maintaining provider data profiles across various enterprise systems. The position suits a specialist who can ensure compliance with health policies and regulatory standards for a large healthcare delivery system.

Responsibilities

• Process initial and reappointment applications using credentialing software, verifying application elements according to Endeavor Health policies, regulatory standards (TJC, CMS), state and federal laws, and third-party payor contracts
• Critically review provider data and verification results to identify any red flags, privilege request issues, and any other application issues, and communicate with key stakeholders (HR, hiring managers, practice managers, Chairman and Division Heads) to resolve issues 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

Requirements

• High School Diploma required
• 2 years of credentialing experience preferred
• Ability to make administrative/procedural decisions and judgments
• 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 priorities, 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 the legal environment in which they operate
• Certified Provider Credentials Specialist (CPCS) through the National Association Medical Staff Services (NAMSS) required

Benefits

• 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

Important Details

• Schedule: Monday-Friday, 7:30a-4:30p

About the Company

Endeavor Health is a fully integrated healthcare delivery system that provides access to quality, community-connected care, serving an area of more than 4.2 million residents across six northeast Illinois counties. The company has over 25,000 team members and more than 6,000 physicians, delivering care across more than 300 ambulatory locations and eight acute care hospitals.