Credentialing Coordinator

Mercyhealth Wisconsin and Illinois; Riverside (OH); On-site; USD 29,000 - 50,000; Full time

Benefits offered by this job

Medical, Dental, Vision

Life & Disability Insurance

FSA/HSA options

Paid time off

Job summary

Mercyhealth is seeking a detail-oriented credentialing specialist to manage provider credentialing and recredentialing. The role ensures compliance with Joint Commission, NCQA, and state/federal guidelines while maintaining accurate provider records and coordinating with stakeholders in a fast-paced healthcare environment.

The position involves full-time hours, administrative support duties, and ongoing attendance at credentialing committee processes to secure approvals.

Qualifications

• Associates degree and 1 year of healthcare-related experience, preferably Med Staff Credentialing.
• Or minimum 3 years of healthcare-related experience, preferably Med Staff Credentialing.

Responsibilities

• Maintains high quality, timely credentialing processes for medical and allied professionals.
• Enters, logs, and scans information for initial appointments, reappointments, and maintenance.
• Ensures compliance and delivery of required information to customers in a timely manner.
• Processes credentialing and recredentialing per Mercy policies, Joint Commission, NCQA, and regulatory guidelines.
• Maintains credentials files and follows up on missing items or incomplete forms.
• Communicates issues to team lead/manager and documents red flags with practitioners.

Skills

Credentialing

Recredentialing

Regulatory compliance

Education

Associates degree

Tools

Credential Stream

Microsoft Office

Job description

OVERVIEW

Detail-oriented credentialing specialist with experience managing provider credentialing and recredentialing while ensuring compliance with regulatory and accreditation standards. Skilled in maintaining accurate provider records, coordinating with stakeholders, and delivering timely, high-quality administrative support in fast-paced healthcare environments.

SCHEDULE

Full Time, 40 hours per week

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Maintains high quality, timely and accurate credentialing processes of medical and allied healthcare professionals based upon system policies and procedures.
• Assists in the credentialing process by entering, logging, scanning information into the system for initial appointments, reappointments, add-on applications and maintenance.
• Completes and ensures compliance and delivery of required information to all customers in a timely manner.
• Processes and maintains credentialing and recredentialing in accordance with Mercy policies and procedures, Joint Commission and NCQA standards, and State and Federal regulatory guidelines.
• Ensures that all credentials are current and complete pursuant to expiration date of medical licensure, board certification, professional liability insurance coverage, DEA and other pertinent information per Mercy policy/procedure.
• Monitors collection of all information received. Follow-up on missing items/documentation/incomplete forms. Submits follow- up requests, as needed.
• Identifies and evaluates potential red flags and works in collaboration with practitioner(s) to document the issue and practitioner response.
• Advises team lead and/or manager of questionable information received and any issues identified during processes.
• Submits closed files for audit/final review and secures missing items as identified by audit/final review.
• Maintains all credentials files to ensure that all correspondence is accurately filed; is knowledgeable and current in regard to process and legal/regulatory requirements.
• Maintains compliance with Mercy policies/procedures, federal, state and all accrediting agencies as required.
• Responds to verification, case log, and proof of malpractice coverage requests from hospitals and managed care organizations.
• Works with agencies and practitioners to assemble credentials files and arranges for review and secures signatures for locum tenens privileges.
• Responsible for taking credentialing files through full approval process, from Credentials Committee to Medical Executive Committee, through the Board Action Report.
• Schedules and secures rooms for Medical Staff meetings, sends out notices, drafts agenda, assembles meeting materials, drafts minutes and follow-up correspondence.
• Maintains practitioner information in credentialing software platform

EDUCATION AND/OR EXPERIENCE

Associates degree AND 1 year of experience in a healthcare-related environment, preferably in Med Staff Credentialing;

OR minimum 3 years of experience in a healthcare-related environment required, preferably in Med Staff Credentialing.

CERTIFICATION/LICENSURE

CPCS or CPMSM preferred.

OTHER SKILLS AND ABILITIES

Experience with credentialing accreditation by The Joint Commission and NCQA.

Demonstrated working knowledge of healthcare and credentialing industry, including

familiarity with Illinois and Wisconsin State laws, regulatory agencies, and other national standards preferred.

Understanding of professional telephone and email correspondence etiquette.

Able to work with minimal supervision and under pressure. Able to work well in an individual and group environment.

Proactively prioritizes needs and displays effective time management. Shows attention to detail.

Communicates clearly and concisely.

Displays autonomous decision-making and critical thinking skills with a strong ability to problem-solve.

Must have excellent interpersonal and written communication skills, including spelling, grammar and basic mathematical calculations.

Establishes and maintains long-term customer relationships by building trust and respect.

Articulates knowledge and understanding or organizational policies and procedures

Demonstrates proficiency in Microsoft Office (Word, Excel and other applications, as required.

Demonstrates knowledge of credentialing software; Credential Stream preferred.

Maintains confidentiality of privileged information.

Knowledge of accepted practices related to primary source verification.

LEVEL OF SUPERVISION

Some independent judgement is required, but alternatives are limited by standard practices and procedures.

SUPERVISES

None.

PAY RANGE

$20.72 - $35.20

Mercyhealth is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identify, national origin, disability, or protected veteran status.

Mercyhealth offers competitive pay and a comprehensive benefits package including:

• Medical, Dental, Vision
• Life & Disability Insurance
• FSA/HSA Options
• Generous, accruing paid time off
• Paid Parental and caregiver leave
• Career advancement and educational opportunities
• Tuition and certification reimbursement
• Certification Reimbursement
• Well-being Programs
• Employee Discounts
• On-Demand Pay
• Financial Education
• Annual recognition/awards events
• Partner appreciation days
• Family entertainment/attractions discount
• Community service/improvement opportunities

At Mercyhealth, we don’t simply hire people, we empower employee-partners who are passionate about making lives better. As an integrated health system, we deliver exceptional, coordinated across seven hospitals, 85 primary and specialty clinics, and a team of over 7,500 professionals serving northern Illinois and southern Wisconsin.

Mercyhealth has been nationally recognized for our commitment to our people and culture, including:

• #1 in the nation on AARP’s Best Employers for Workers Over 50
• One of Working Mother magazine’s 100 Best Companies for Working Mothers
• A Top 50 Company and Top 10 Nonprofit for Executive Women