Team Lead Credentialing

4 weeks ago


Janesville, United States Mercy Health System Full time

JOB REQUIREMENTS: Overview Credentialing Team Lead, Medical Staff, Days, 80 Hrs / 2 wks Location: Mercyhealth Trauma Center; Janesville, WI or Rockton Ave Campus; Rockford, IL. Hybrid work schedule opportunity avaliable after training period. The Credentialing Team Lead works as a liaison between Medical Staff Office management and partners, communicating policies, procedures and workflows, as well as providing training and monitoring work volumes. Performs other duties as assigned. Responsibilities The Team Lead will provide consistent, accurate and timely credentialing support, enhancing Mercy System\'s ability to provide professional services, including timely and accurate verification, validation and documentation of the information provided by all applicants; ensures provider files are kept confidential at all times; coordinates operations with other departments to ensure smooth workflow; assists with short-term and long-term goal setting. Assists with direct aspects of the credentialing and privileging processes for health care providers, including processing applications, verifying information, researching application details and ensuring processes are in accordance with medical staff bylaws. Assists with accurate and complete data entry of credentialing information into the credentialing database. Develop into database super user and work with database support staff to ensure updates are implemented. Responds to inquiries regarding credentialing status, handles provider correspondence as necessary to process applications, and maintains knowledge of and compliance with TJC, NCQA, CAQH, and CMS standards, as appropriate. Assists with the coordinator hiring process and training of new employees. Provides mentoring to staff members and assists with performance appraisals, disciplinary actions, and other HR relations. Audits and monitors all Medical Staff Office and Credentialing processes and individual partner performance to assure compliance with department policies and procedures; includes oversight and management of internal quarterly auditing to ensure compliance with external NCQA and CMS credentialing standards and for reporting to payers during annual delegated audits. Works in collaboration with the Quality department to coordinate all Credentialing Committee, Medical Executive Committee, and All Staff Meetings for all Mercy facilities. Reviews data and develops reports and other tools to identify areas for improvement and to set and track benchmarks and productivity based on industry standards; provides internal departments with needed reports on identified schedule or upon ad-hoc request. Assists in overseeing collaboration between Medical Staff Office, Enrollment, Quality, Provider Recruitment, Revenue Cycle, and Information Systems to ensure effective communication... For full info follow application link. EOE&AA/M/F/Vet/Disabled. Mercy is an equal employment opportunity employer functioning under Affirmative Action Plans. ***** APPLICATION INSTRUCTIONS: Apply Online: ipc.us/t/9179EAF465CC4A55


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