Credentialing Coordinator Sr

10 HOSP Ann & Robert H. Lurie Children's Hospital of Chicago; Chicago (IL); On-site; USD 29,000 - 45,000; Full time

Benefits offered by this job

Medical, dental and vision insurance

403(b) with 5% employer match

Paid Time Off and holidays

Job summary

Ann & Robert H. Lurie Children’s Hospital of Chicago seeks a Credentialing Specialist to support primary source verification and credentialing processes for managed care providers. The role collaborates with the FPP team, contributes to billing and compliance activities, and ensures timely credentialing for physicians.

The ideal candidate has a BA (or 2+ years credentialing experience), CPCS eligibility, and NCQA audit familiarity, with strong data skills in Excel/Access and detail orientation.

Qualifications

• BA preferred or minimum two years experience in credentialing and recredentialing.
• Must be eligible for CPCS certification by NAMSS.
• Experience with NCQA audits.

Responsibilities

• Manage credentialing and recredentialing per NCQA and state/federal guidelines.
• Coordinate materials for Credentialing Committee and develop policies.
• Handle credentialing for FPP physicians and new/existing providers.
• Develop billing invoices and manage site visits and medical record reviews.
• Input data into credentialing databases and generate monthly reports.
• Maintain physician portfolios and communicate with payors.
• Resolve issues with payors and families; follow up on payor rosters.
• Review regulatory standards to ensure compliance.
• Coordinate malpractice verification with Risk Management and other admins.
• Provide credentialing training to staff and managers.

Skills

Credentialing

CPCS eligibility

Data entry

Education

Bachelor's degree preferred

Two years credentialing experience

Tools

Microsoft Excel

Access 97+

Job description

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.

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.

Education 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

Benefit Statement 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
• 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]

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.