Credentialing Coordinator II

MyMichigan Medical Group; Midland (MI); On-site; USD 55,000 - 75,000; Full time

Job summary

MyMichigan Health seeks a Credentialing Specialist to plan, coordinate, implement and direct credentialing and recredentialing for medical staff, ensuring compliance with CMS Regulations and Joint Commission standards.

The role oversees daily credentialing operations, verifies licensure and certifications, handles initial appointments and reappointments, and liaises with executives, staff coordinators, recruiters, and external customers. Strong communication and detail orientation are essential.

Qualifications

• Bachelor’s degree in business or health related field is required.
• Two years experience in Medical Staff Services or a managed care organization preferred.
• All staff hired after 5/23/13 are required to obtain CPCS within five years of hire.
• Extensive knowledge of credentialing and privileging processes preferred.

Responsibilities

• Coordinate and oversee credentialing processes including primary source verification and evaluation of practitioner data.
• Manage initial appointment and reappointment processes per CMS, Joint Commission, and UMHS requirements.
• Address inquiries and confidential matters with professionalism and customer service.
• Act as liaison between the CEO, medical staff coordinators, department leaders, recruiters, and external customers.
• Assist with Joint Commission surveys and ongoing accreditation activities.

Skills

Interpersonal skills

Problem-solving

Communication

Team player

Time management

Education

Bachelor's degree in business or health related field

CPCS certification within five years of hire

Tools

PowerPoint

Excel

Database management

Word

Job description

Summary

This position plans, coordinates, implements and directs the MyMichigan Health (MMH) medical staff credentialing and recredentialing functions. This position is responsible for evaluating provider credentials to assure compliance with UMHS Conditions of Use, CMS Regulations and Joint Commission standards. This position assists with preparation and participates in accreditation surveys. The Credentialing Specialist oversees the daily operation of the credentialing functions.

Responsibilities

• (40%) Coordinates, implements and oversees the credentialing processes by applying expert knowledge and experience. In addition to primary source verification of licensure, training, and certification, the specialist evaluates practice data to determine if requirements have been met. Acting as a specialist in the complex MyMichigan Health credentialing process, has the authority to make independent decisions through analyzing, comparing, and evaluating various courses of action. Accountability for verifying documentation, investigating and validating discrepancies.
• (20%) Responsible for initial appointment/reappointment and credentialing with UMHS Conditions of Use, CMS regulations, and Joint Commission guidelines and standards.
• (20%) Responds to inquiries and/or complaints regarding matters of a sensitive or confidential nature, exercising initiative, independent judgment, and diplomacy, with an excellent customer service oriented attitude.
• (15%) Serves as liaison between the Chief Executive Officer, subsidiary Medical Staff Coordinators, medical staff clinical department leaders, recruiters, and external customers.
• (5%) Assists with preparation and participates in Joint Commission surveys to assure.
• OTHER DUTIES AND RESPONSIBILITIES:
  • Demonstrated excellent interpersonal, problem-solving, and communication skills, both written and oral.
  • Excellent organizational and multi-tasking skills.
  • Ability to work effectively, cooperatively, and professionally with a diverse group of medical staff providers and clinical staff.
  • Must be a team player.
  • Possess the ability to meet tight deadlines and handle changing priorities professionally.
  • Excellent planning, coordination, presentation, communication and interpersonal skills, self-motivated and able to function independently with a positive attitude. Typing and computer skills: proficiency with Power Point, Excel, database management, and Word required.
  • Must be extremely accurate and detail oriented. Must be able to exercise good judgment and work under pressure, with strong time management skills.
  • MidMichigan Health is a technology driven organization and employees need to demonstrate competency in Microsoft Windows. An employee may be required to participate in further learning opportunities offered by MyMichigan Health.
  • All other duties as assigned.

Certifications and Licensures

• CPCS - Cert Provider Credential Spec
• Preferred Equivalent Experience - All staff hired into this position after 5/23/13 are required to obtain Certification as Certified Provider Credentialing Specialist (CPCS) within five years of hire or transfer into position.

Required Education

• Education: Bachelors Degree
• Comments: Bachelor’s degree in business or health related field is required.

Other Information

• Experience, Training and Skills: Two (2) years experience in Medical Staff Services or a managed care organization preferred.
• All staff hired into this position after 5/23/13 are required to obtain Certification as Certified Provider Credentialing Specialist (CPCS) within five (5) years of hire or transfer into position.
• Extensive knowledge of credentialing and privileging process preferred.

PHYSICAL/MENTAL REQUIREMENTS AND TYPICAL WORKING CONDITIONS

• Exposure to stressful situations, including those involving public contact, as well as, trauma, grief and death.
• Able to wear personal protective equipment that includes latex materials or appropriate substitute if required for your position.
• Is able to move freely about facility with or without an assisted device and must be able to perform the functions of the job as outlined in the job description.
• Overall vision and hearing is necessary with or without assisted device(s).
• Frequently required to sit/stand/walk for long periods of time. May require frequent postural changes such as stooping, kneeling or crouching.
• Some exposure to blood borne pathogens and other potentially infectious material. Must follow MyMichigan Health bloodborne pathogen and TB testing as required.
• Ability to handle multiple tasks, get along with others, work independently, regular and predictable attendance and ability to stay awake.
• Overall dexterity is required including handling, reaching, grasping, fingering and feeling. May require repetition of these movements on a regular to frequent basis.
• Physical Demand Level: Light. Must be able to occasionally (0-33% of the workday) lift or carry 11-20 lbs., frequently (34-66% of the workday) 10 lbs. and or Walk/Stand/Push/Pull of Arm/Leg controls.