Credentialing Specialist

2 weeks ago

Kansas City, MO, United States Swope Health Services Full time

Swope Health is seeking a organized, detailed oriented Credentialing Specialist to work closely with our provider staff to ensure the organization has a provider network of the highest quality. The Credentialing Specialist is responsible for coordinating the centralized credentialing and privileging program. The Credentialing Specialist develops and implements processes, procedures, and policies in accordance with standards established by HRSA, Joint Commission and other grant makers as applicable. You will play a vital role in ensuring patient safety and quality care. If you have a passion for community-based care. Join Swope Health and help shape the future of equitable, patient-centered healthcare in our region.

Primary Functions:

  • Develops and implements centralized credentialing and privileging processes and procedures for Swope practitioners and maintains confidential credentialing files.
  • Prepares credentialing and privileging documents for all initial appointments and reappointments in a timely and complete manner for presentation to the Board of Directors.
  • Works closely with physicians, mid-levels, licensed independent practitioners and other licensed or certified practitioners and professional staff to acquire necessary materials and information for enrollment with commercial insurance plans.
  • Ensures compliance with HRSA, JCAHO and other grant makers or certification standards for credentialing and privileging of various practitioner types.
  • Maintains and/or acquires delegated credentialing as appropriate to benefit Swope Health.
  • Uses credentialing software proficiently and adds credentialing information to the HR associate record as necessary.
  • Coordinates with various departments to ensure communication of completed credentialing and privileging requirements to ensure appropriate billing for services.
  • Convenes monthly Credentialing Committee meetings, prepares agenda and records, and ensures the decisions of the committee are acted upon. Attends Board meetings as required.
  • Coordinate with the HR Talent Acquisition team on new hire credentialing and provider enrollment.
  • Ensure team members follow best practices and maintain service level agreements
  • Monitors/resolve team issues and associate concerns
  • Suggest or innovate on processes as deemed appropriate
  • Exercises confidentiality with regard to all information, results, data and other sensitive material.
Education and Qualification Requirements:
  • Associates Degree in Business Administration or equivalent experience, Bachelor’s Degree preferred.
  • 3-5 years credentialing experience or relevant work experience required.
    Certified Provider Credentialing Specialist certification preferred.


About Swope Health Services:

For 56 years, the mission of Swope Health mission has been to improve the health and wellness of the community by delivering accessible, quality, comprehensive patient care to all. Founded in 1969 by E. Frank Ellis, Swope Health opened as “Model Cities Health Corporation” in the basement of Metropolitan
Missionary Baptist Church with 20 associates and a $100,000 budget to serve 2,000 patients a year. Since then, Swope has since expanded its size, scope, and service offerings to include behavioral and dental care, services for the unhoused, mobile services and school-based clinics, and the PACE KC Adult Wellness Center.

Swope Health serves as a community health asset in the region – transforming lives, strengthening community, and powering our prosperity. Swope Health is committed to maintaining its focus on patient care and experience as well as an integrated, holistic model of health care, ensuring that everyone in the community can be served. The organization’s high-quality services, strong financials, and visionary leadership team position them well to sustain and deepen their impact into the future.

Swope Health Services supports its team members with:

1. Medical benefits (including a Health Savings Account option), dental and vision
2. 401(k) retirement plan with company match
3. Company-paid benefits such as life insurance, Accidental Death & Dismemberment, and Short- and Long-Term Disability
4. Flexible Spending Account
5. Paid Days Off beginning at 15 days annually.
6. Nine annual company-paid holidays; One annual paid personal day

Swope Health is an affirmative-action, equal-opportunity employer. We consider all qualified applicants without regard to race, color, creed, religion, gender, national origin, age, marital status, veteran status, or di

Equal Opportunity Employer

This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.

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