Credentialing & Recredentialing Lead — NCQA Expert

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

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.