Credentialing Specialist
2 weeks ago
Under the direction of the Manager, the Credentialing Coordinator will have responsibility for coordinating, monitoring, and maintaining the credentialing and re-credentialing of Provider Applicants. This includes facilitating all aspects of appointment, reappointment, and privileging maintenance for managed care, medical staff, and non-physician providers.
Key Responsibilities- Collect relevant and critical data to determine applicant's eligibility to be credentialed.
- Evaluate and review applications for accuracy and completeness.
- Gather and conduct verification of confidential healthcare provider credentials.
- Contact and follow up with contracted managed care payers, Departments, and contracted MSO facilities to obtain documentation relevant to the credentialing process and data entry of all credentialing information provided by Departments and contracted MSO facilities.
- Ensure all expirable documents are reviewed, obtained and managed on a monthly basis according to rules and policies.
- Process and record re-credentialing cycles.
- Maintain the confidentiality of all business, work and credentialing information.
- Coordinate and prepare reports and packets for the Rush Health Peer Review Committee (PRC) monthly meeting.
- Assist in managing the flow of information between the managed care payers, contracted MSO facilities and Rush Health.
- Process and communicate all Rush Health practitioner additions, deletions, and/or changes to all contracted managed care payers.
- Assist in preparing for managed care credentialing, contracted MSO facility audits.
- High School Diploma or GED
- Two years' of collegiate or industry specific training.
- National Association of Medical Staff Services preferred
- One year in provider credentialing.
- One year experience in healthcare or managed care industry.
- Bachelor's degree.
- Three years of relevant work experience in healthcare administration or academic medicine.
- Experience in healthcare or higher education.
- Familiarity with medical terminology.
- Excellent organizational skills and attention to detail.
Rush is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.
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