Credentialing Assistant - Clinical Practice Services

mcw; Wauwatosa (WI); Hybrid; USD 25,000 - 30,000; Full time

Benefits offered by this job

Health insurance

Tuition reimbursement

Paid parental leave

EFAP (Employee & Family Assistance)

Job summary

MCW is seeking Credentialing Assistants to support background verification, file preparation, and enrollment maintenance for provider and clinical site credentialing. The role requires attention to detail and accuracy in a high-volume environment.

Position is hybrid (60% onsite, 40% remote) and requires residence in the Metro Milwaukee, WI area. The team handles Medicare/Medicaid enrollment and CBAP processes for hiring and credentialing decisions.

Qualifications

• High school diploma required.
• At least 2 years of related experience preferred.

Responsibilities

• Prepares re-credentialing files for review by MCW Credentialing Committees.
• Verifies information from identified primary sources and pursues missing forms.
• Prepares Individual Status Reports from primary source verifications.
• Enrolls new MCW providers into Medicare and Medicaid programs and ensures application completeness.
• Coordinates with government payers to secure and transmit enrollment materials.
• Prepares CBAP files for review in hiring decisions for clinical departments.
• Maintains CBAP candidate records and tracks progress in spreadsheets.

Skills

Quality control

Customer service

Information management

Recordkeeping

Interpersonal skills

Oral communication

Listening

Patience

Education

High school diploma

Tools

Spreadsheet software

Job description

Summary

Credentialing Assistants perform a variety of duties that contribute to background verification and file preparation for the MCW credentialing function, and enrollment and maintenance of enrollment status of individual providers and clinical practice sites for public payer programs. The tasks that Credentialing Assistants perform require a consistently high degree of accuracy over a large volume of providers, and their work, though closely supervised, is relied upon and used directly in decisions regarding credentialing and enrollment.

Hybrid position: 60% Onsite, 40% Remote, must live in Metro Milwaukee, WI area.

Primary Responsibilities

• Prepares re-credentialing files for review and decision by MCW Credentialing Committees.
• Verifies specified information from identified primary sources, reviews re-credentialing applications for completeness, and pursues missing forms or information as needed.
• Prepares Individual Status Reports using information obtained from primary source verifications including assembling all re-credentialing information regarding each provider into re-credentialing files for review by MCW Credentialing Committees.
• Enrolls all newly hired MCW providers into Medicare and appropriate Medicaid programs by receiving applications for participation in Medicare and Medicaid programs from new providers. Checks for completeness and pursues additional information or materials as necessary.
• Works with personnel from government payers to secure application materials as necessary. Transmits completed applications to government payer; receives and files verification of enrollment.
• Prepares Candidate Background Assessment Program (CBAP) files for review and use in hiring decisions for clinical departments.
• Receives CBAP applications from candidates for faculty physician, dentist, and psychologist positions and verifies specific information from primary sources.
• Reports results of CBAP background searches to Office of General Counsel and clinical departments.
• Maintain records noting progress of each candidate in the CBAP process in spreadsheet software.
• Maintains individual files for all candidates using the CBAP process.

Knowledge - Skills - Abilities

• Knowledge of quality control, customer service standards, information management, procedural process, and recordkeeping.
• Computer, technical, interpersonal, oral communication, listening, and patience skills.

Qualifications

• Minimum Required Education: High school diploma
• Minimum Required Experience: 2 years

Physical Requirements

Work requires occasionally lifting moderate weight materials, standing, or walking continuously.

Work Environment

Occasional exposure to dust, noise, temperature changes, or contact with water or other liquids. Work is performed in an environmentally controlled environment.

Sensory Acuity

Ability to detect and translate speech or other communication required. May occasionally require the ability to distinguish colors and perceive relative distances between objects.

Why MCW?

• Outstanding Healthcare Coverage, including but not limited to Health, Vision, and Dental. Along with Flexible Spending options
• 403B Retirement Package
• Competitive Vacation and Paid Holidays offered
• Tuition Reimbursement
• Paid Parental Leave
• Employee & Family Assistance Program (EFAP)
• Pet Insurance
• On campus Fitness Facility, offering onsite classes
• Additional discounted rates on items such as: Select cell phone plans, local fitness facilities, Milwaukee recreation and entertainment etc.

For a brief overview of our benefits see: Benefits Overview

For a full list of positions see: MCW Careers

At MCW all of our endeavors, from our internal operations to our interactions with our partners, are driven by our shared organizational values: Caring - Collaborative - Curiosity - Inclusive - Integrity - Respect. We are committed to fostering an inclusive environment that values diversity in backgrounds, experiences, and perspectives through merit-based processes and in alignment with all applicable laws. We believe that embracing human differences is critical to realize our vision of a healthier world, and we recognize that a healthy and thriving community starts from within. Our values define who we are, what we stand for and how we conduct ourselves at MCW. If you believe in embracing individuality and working together according to these principles to improve health for all, then MCW is the place for you. For more information, please visit our institutional website.

MCW as an Equal Opportunity Employer and Commitment to Non-Discrimination:

The Medical College of Wisconsin (MCW) is an Equal Opportunity Employer. We are committed to fostering an inclusive community of outstanding faculty, staff, and students, as well as ensuring equal educational opportunity, employment, and access to services, programs, and activities, without regard to an individual's race, color, national origin, religion, age, disability, sex, gender identity/expression,