Credentialing Coordinator Sr

Ann & Robert H. Lurie Children's Hospital of Chicago; Chicago (IL); On-site; USD 26,000 - 44,000; Full time

Job summary

Ann & Robert H. Lurie Children’s Hospital of Chicago is seeking a Credentialing Specialist to support primary verification, maintain NCQA-aligned credentialing processes, and ensure compliance with licensing and accrediting requirements.

The role involves updating physician applications, coordinating with payors, and maintaining accurate credentialing portfolios. The candidate will manage credentialing for FPP clients, assist with committee approvals, and train staff on credentialing

Qualifications

• BA preferred or minimum two years experience in credentialing and recredentialing process.
• Must be eligible for CPCS credentialing.
• Must have NCQA audit experience.
• Proficient in Microsoft Excel and Access.

Responsibilities

• Manages credentialing and recredentialing processes according to NCQA Standards, State and Federal guidelines, FPP Policies and Procedures, and FPP Bylaws.
• Coordinates materials for FPP Credentialing Committee; assists Director of Credentialing with FPP Credentialing and Recredentialing Policies and Procedures.
• Follows through with Credentialing Committee approvals.
• Adheres to State recredentialing cycles.
• Responsible for credentialing and recredentialing for FPP clients; Responsible for the credentialing and recredentialing process for new and existing FPP physicians.
• Develops billing invoices and calculates receivables for FPP clients.
• Responsible for FPP site visits; Medical Record reviews, and for querying National Practitioner Data Bank.
• Inputs data into FPP Credentialing database software and provide monthly querying of federal and state Medicare sanction databases.
• Maintains physician portfolios and files and sends physician demographics, adds, terminations and changes to managed care payors electronically or by paper copy.
• Resolves issues regarding credentialing from payors, Lurie Children’s staff and families via phone, fax or letter. Follows up with payors on any issues and reconciliations of payor rosters to ensure accuracy
• Reviews current regulatory standards to ensure compliance.
• Develops a credentialing training program for Office Coordinators; training Office Coordinators, Academic Office Coordinators, Point of Service and Managers regarding managed care credentialing.
• Coordinates malpractice verification with Risk Management; hospital verifications and credentialing eligibility with Practice Plan Administrators and Medical Staff Office;

Skills

Credentialing

Communication

NCQA audit

Excel/Access

Education

BA preferred

Tools

Excel

Access

Job description

Ann & Robert H. Lurie Children’s Hospital of Chicago provides superior pediatric care in a setting that offers the latest benefits and innovations in medical technology, research and family-friendly design. As the largest pediatric provider in the region with a 140-year legacy of excellence, kids and their families are at the center of all we do. Ann & Robert H. Lurie Children’s Hospital of Chicago is ranked in all 10 specialties by the U.S. News & World Report.

Location

680 Lake Shore Drive

Job Description

Minimum Qualifications Required-

BA preferred or minimum two years experience in credentialing and recredentialing process.

Must be eligible for certification by National Association of Medical Staff Services as a Credentialing Specialist (CPCS).

Must have experience with an NCQA audit.

General Understanding And Nature Of The Position Description

Provides support to the FPP Managed Care Administrator of Management Services and Director of Credentialing in the above areas through primary source verification of information provided on the provider’s application. Responsible for maintaining a credentialing process in accordance with NCQA and other State and Federal Regulatory Agencies. Processes and updates physician applications and sends completed applications to managed care contracted entities. Responsible for helping to ensure compliance with NCQA, licensing and accrediting agency requirements.

Essential Job Functions

• Manages credentialing and re-credentialing processes according to NCQA Standards, State and Federal guidelines, FPP Policies and Procedures, and FPP Bylaws.
• Coordinates materials for FPP Credentialing Committee; assists Director of Credentialing with FPP Credentialing and Recredentialing Policies and Procedures;
• Follows through with Credentialing Committee approvals;
• Adheres to State recredentialing cycles
• Responsible for credentialing and recredentialing for FPP clients; Responsible for the credentialing and recredentialing process for new and existing FPP physicians
• Develops billing invoices and calculates receivables for FPP clients;
• Responsible for FPP site visits; Medical Record reviews, and for querying National Practitioner Data Bank.
• Inputs data into FPP Credentialing database software and provide monthly querying of federal and state Medicare sanction databases
• Maintains physician portfolios and files and sends physician demographics, adds, terminations and changes to managed care payors electronically or by paper copy.
• Resolves issues regarding credentialing from payors, Lurie Children’s staff and families via phone, fax or letter. Follows up with payors on any issues and reconciliations of payor rosters to ensure accuracy
• Reviews current regulatory standards to ensure compliance.
• Develops a credentialing training program for Office Coordinators; training Office Coordinators, Academic Office Coordinators, Point of Service and Managers regarding managed care credentialing.
• Coordinates malpractice verification with Risk Management; hospital verifications and credentialing eligibility with Practice Plan Administrators and Medical Staff Office;

Knowledge, Skills And Abilities

• BA preferred or minimum two years experience in credentialing and recredentialing process.
• Certification/Licensure/Registration: Must be eligible for certification National Association of Medical Staff Services as a Credentialing Specialist (CPCS).
• Must have experience with an NCQA audit.
• Data processing proficiency in Microsoft Excel and Access 97 or higher.
• Ability to work under pressure, be detail oriented, and have excellent cognitive and communication skills.

Pay Range

$21.00-$32.55 Hourly

At Lurie Children’s, we are committed to competitive and fair compensation aligned with market rates and internal equity, reflecting individual contributions, experience, and expertise. The pay range for this job indicates minimum and maximum targets for the position. Ranges are regularly reviewed to stay aligned with market conditions. In addition to base salary, Lurie Children’s offer a comprehensive rewards package that may include differentials for some hourly employees, leadership incentives for select roles, health and retirement benefits, and wellbeing programs.

Benefit Statement

Benefits

For full time and part time employees who work 20 or more hours per week we offer a generous benefits package that includes:

• Medical, dental and vision insurance
• Employer paid group term life and disability
• Employer contribution toward Health Savings Account
• Flexible Spending Accounts
• Paid Time Off (PTO), Paid Holidays and Paid Parental Leave
• 403(b) with a 5% employer match

Various Voluntary Benefits

• Supplemental Life, AD&D and Disability
• Critical Illness, Accident and Hospital Indemnity coverage
• Tuition assistance
• Student loan servicing and support
• Adoption benefits
• Backup Childcare and Eldercare
• Employee Assistance Program, and other specialized behavioral health services and resources for employees and family members
• Discount on services at Lurie Children’s facilities
• Discount purchasing program

There’s a Place for You with Us

At Ann & Robert H. Lurie Children’s Hospital of Chicago and its affiliates (collectively “Lurie Children’s”), we embrace and celebrate diversity and equity in a serious way. We are committed to building a team with a variety of backgrounds, skills, and viewpoints — recognizing that diverse identities strengthen our workplace and the care we can provide to the Chicago community and beyond. We treat everyone fairly, appreciate differences, and make meaningful connections that foster belonging and allyship. This is a place where you can be your best, so we can give our best to the patients and families who trust us with their care.

Lurie Children’s and its affiliates are equal employment opportunity employers. We value diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity or expression, religion, national origin, ancestry, age, disability, marital status, pregnancy, protected veteran status, order of protection status, protected genetic information, or any other characteristic protected by law.

For questions about how to request an accommodation please contact: [e-mail]

AI Notice

Lurie Children’s utilizes certain AI-enabled features within our recruiting platform to support candidate engagement and assist recruiters in identifying and prioritizing applicants whose experience aligns with job requirements. All employment decisions are made by individuals.

It is a civil rights violation with respect to recruitment, hiring, promotion, or employment for an employer to use artificial intelligence that has the effect of subjecting employees to discrimination on the basis of protected classes under the Illinois Human Rights Act or to use zip codes as a proxy for protected classes.

For questions about the use of artificial intelligence in this process or any additional support, please contact: [e-mail]