Requisition ID: 45001
Location: Bolingbrook Corporate
1000 Remington Boulevard, Bolingbrook, IL 60440-5114 United States (US)
Daily Hours: 8
Standard Hours: 24
Employment Status: Part-time
Employment Type: Regular
Credentialing Specialist - TeleHealth
This position is part time and located at 1000 Remington Blvd, Bolingbrook, IL 60440
The Credentialing Specialist is under the leadership of the RN TeleHealth Manager and may also receive direction from System Director Telehealth Strategy and Growth as well as Regulatory. Supports all Telehealth credentialing processes for initial and re-application. This is including but not limited to, primary source verifications, references and follow up to complete TeleHealth credentialing clinician efficient and complete documents for requested TeleHealth privileges. Works efficiently and effectively in accordance with established regulatory agencies, accreditation organizations, Managed Care Organizations, All Presence Health entities, Central Verification Office and medical staff offices of TeleHealth outreach, Medical Staff Bylaws and specific credentialing policies and procedures of entity that credentialing is being sought.
Essential Duties & Responsibilities:
Is responsible for coordinating the initial and re-credentialing primary source verification process for all Physicians and Clinicians requiring credentialing for TeleHealth Programs. Maintains MD Staff, other pertinent databases for all TeleHealth Clinicians with credentialing requirements. Maintains up to date TeleHealth files for all regulatory and Health System educational clinician requirements.
Primary Source Verification and Monitoring
- Primarily responsible for reappointment applications. Supports the primary source verification process for initial applications. This function includes processing of all primary source queries.
- Performs timely monthly monitors and reviews of practitioners' related credentialing expirations such as licenses, DEA/CSL, certificates and certificates of insurance.
- Duties include the gathering, verification and evaluation of healthcare practitioner and/or provider credentials.
- Works closely with Credentialing Coordinator to assure completeness, accuracy and timely processing of an application or reappointment for Medical Staff membership, Allied Health privileging, or delegated credentialing.
- Monitors, analyzes and tracks responses for accuracy and quality of information received, determines and pursues additional investigation, as required, thus enabling complete files for all entities where credentialing is being requested.
- Advises the Manager in a timely manner of problems with physicians and/or practitioners credentials files.
- Maintains physician, provider, and other practitioner credentialing electronic files.
- Maintains integrity of credentialing database, assuring it is kept accurate and current at all times.
- Full understanding of all technical aspects of the credentialing database. Utilizes database and follows procedures outlined in the system credentialing data entry manual as well as outreach files.
- Maintains electronic files of OPPE/FPPE and communicates need for any updates
- Performs periodic internal audits of electronic credentialing files. Prepares audit summary reports and provides to manager on regular basis.
- . Maintains PHP provider file with the required provider credentials using the MD Staff database, in accordance with HMO/PPO and delegated credentialing requirements.
- Regularly audits provider files for the correct, up-to date required credentials using the provider credentialing database, in accordance with HMO/PPO and delegated credentialing requirements established regulatory agencies, accreditation organizations, Managed Care Organizations, PHP, Medical Staff Bylaws, and Hospital and Medical Staff policies.
- Audits various processes to ensure compliance with credentialing delegation requirements, including government sanctions providers.
- Prepares for credentialing audits by accrediting bodies and delegated physician file audits by health plans.
Communication, Confidentiality, and Other Responsibilities
- Keeps applicants, ministries' Medical Staff offices, and outreach entities informed of the status of the applications and reappointments. If the file is incomplete, the Credentialing Specialist will work clinician for needed documents. If unable to obtain documents credentialing specialist will institute chain of command.
- Maintains the confidentiality, accuracy, and integrity of all business/work and Licensed independent practitioner/ medical staff information according to federal and state guidelines.
- Assists System Director, TeleHealth administrative Assistant with clerical support for assignments as needed.
- Completes work assignments according to established department goals and policies.
- Excellent customer service skills required.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and/or Experience
High school diploma or general education degree (GED) required; college certificate or degree preferred. 1-2 years of experience in healthcare, credentialing/medical staff office, or managed care credentialing experience preferred.
Must be detailed oriented, organized with strong sense of ownership and responsibility. Must have ability to use independent judgment to manage and prioritize the multiple tasks and deadlines in a professional and positive manner. Attention to details required.
Intermediate to advanced PC skills: Web proficiency / internet; database management; MSWord required. Experience in MD-Staff or Morrisey databases, MSExcel and MSAccess preferred.
Business Unit: Corporate (LRHC and LPH)
Department Name: TeleICU Operations