Credentialing Specialist (Hybrid)

Erie Family Health Centers; Chicago (IL); On-site; USD 55,000 - 70,000; Full time

Benefits offered by this job

Competitive benefits package

Generous time off

Retirement plan

Job summary

Erie Family Health Centers seeks a Credentialing Specialist to manage credentialing and privileging for licensed practitioners and staff, ensuring accuracy and regulatory compliance.

You will serve as a key liaison, independently investigating discrepancies and preparing data for review by senior leadership and committees, while staying current with state and federal requirements and payer policies.

Qualifications

• High School diploma or equivalent required.
• Certified Professional Credentialing Specialist by National Association of Medical Staff Services preferred.
• Bachelor's degree is a plus.

Responsibilities

• Uniformly applies defined credentialing and privileging processes and conducts primary source verification.
• Serves as main contact for credentialed providers during credentialing processes.
• Independently investigates credential information and prepares data for senior leadership review.

Skills

Computer skills

Independent worker

Cultural competency

Communication skills

Problem solving

Credentialing standards

Clinical competence knowledge

Adaptability

Education

High School diploma

Certified Professional Credentialing Specialist

Bachelor's degree

Tools

Microsoft Office

Credentialing software

Databases

Job description

Join the Erie team! Motivated by the belief that healthcare is a human right, we provide high quality affordable care to support healthier people, families, and communities. Erie delivers holistic care to help every member of the family stay healthy and active from infancy through adulthood. Since 1957, we have provided high-quality care to diverse patients most in need, regardless of their insurance status, immigration status, or ability to pay. Erie Family Health Centers, a nationally recognized top workplace with 14 sites in Chicago and suburbs, is looking for a valuable addition to our Credentialing team! The Credentialing Specialist works independently, consistently managing the applications of credentialing and privileging processes for all practitioners and other credentialed staff. They recognize potential discrepancies and adverse information on credentialing applications and privilege requests, independently investigate and validate information, and elevate all discrepancies and risks to the appropriate level before the information is presented to decision-making stakeholders. The Senior Credentialing Specialist demonstrates an advanced understanding of state and regulatory standards and is independently motivated to seek resources to remain their knowledge updated on regulatory standards. At Erie, we are proud to provide competitive salaries, high-quality health care plans, generous time off benefits, retirement benefits, and more! Erie employees are eligible for Erie's Full Benefits Package that includes Medical, Dental, Vision, Life and Disability Insurance and Flexible Spending (FSA) for Health Care or Childcare. Retirement Programs: 401(k) program with Erie matching $0.50 for every $1.00 up to the first 5% of the employee’s biweekly salary. Annual Paid Time Off: starting at 20 days of PTO, and 8 paid holidays. Competitive salary, annual merit increases, plus room for growth and career advancement.

• Compensation is based on each candidate’s experience, skills and education within the range identified for the role. Candidates who meet the minimum requirements of the role will start at entry in the range. Any additional skills, experience and education will be reflected in the compensation offered.

Main Duties & Responsibilities

• Uniformly applies defined credentialing and privileging processes and consistently manages the primary source verification of initial and recredentialing and privileging processes for licensed practitioner providers and staff to include education, training, licensure, and peer references, within the defined period required by regulatory, accrediting bodies and payer plans.
• Serves as a main point of contact for credentialed providers and staff during the initial and recredentialing and privileging processes, providing timely updates and additional information as requested.
• Independently investigates and validates credential information, applications, and primary source verifications; accurately maintains practitioner provider and staff data; prepares the checklist profiles for presentation of the practitioner-specific data, finding, and actions for review by the senior provider leaders for privileges review, and key decision-making bodies such as the Board Quality Improvement Committee (“BQI”).
• Complies with internal and external requirements related to verifying the status of all credentialed practitioner provider/staff expirables such as licenses and certifications and initiates verification sources to ensure compliance.
• Serves as resource and communicates with Credentialing Department leadership, other Erie departments or teams, and external business partners regarding the status of the credentialing process of their applicants to ensure the flow of information to key stakeholders.

Qualifications

Education

Required

• High School diploma or equivalent required.

Preferred

• Certified Professional Credentialing Specialist by National Association of Medical Staff Services
• Bachelor's degree a plus

Experience

Required

• Two years of current work experience in Credentialing.

Preferred

• Experience in applying privileging criteria a plus.

Skills And Knowledge

Required

• Basic computer skills including Microsoft Office and credentialing software and databases
• Ability to work independently without constant oversight, set work priorities, determine goals and strategies to achieve them
• Cultural competency to work with a diverse practitioner population
• Ability to communicate properly and effectively in verbal and written form with various levels of practitioners, hiring managers, and senior provider leaders
• Apply knowledge, expertise, sound judgment, and other resources as necessary to generate and evaluate solutions and recommendations
• Ability to consistently apply the state, federal and accrediting standards for credentialing and privileging
• Ability to understand clinical competence as related to privileging criteria and evaluation tools and techniques used for demonstrating competence
• Ability to adapt behavior in response to new information, changing circumstances and performance improvement concepts

Preferred

• Intermediate proficiency in Microsoft Office a plus.
• Advanced credentialing software and database skills are a plus.

The Erie Advantage Pledge

Working Together For What Matters Most

• Our mission, vision, and values unite us.
• Our voices matter.
• We do things well.
• Our inclusive culture promotes balance and belonging.
• We find our career sweet spot at Erie.