Credentialing Specialist (Hybrid)

Erie Family Health Center; Chicago (IL); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Full benefits package

Medical insurance

Dental insurance

Vision insurance

401(k) with Erie match

PTO 20 days + 8 holidays

Job summary

Erie Family Health Center is seeking a Credentialing Specialist to manage credentialing and privileging processes for licensed practitioners and staff across our network.

You will independently investigate credential information, maintain data accuracy, and prepare documentation for review by senior leaders.

Qualifications

• Two years of credentialing experience.
• High School diploma or equivalent required.
• Certified Professional Credentialing Specialist preferred.
• Bachelor’s degree a plus.

Responsibilities

• Uniformly applies credentialing and privileging processes and manages primary source verification for initial and recredentialing.
• Investigates and validates credential information, applications and verifications; maintains data accurately.
• Prepares checklists and presents practitioner data to senior leaders and boards for privileges review.
• Verifies status of licenses and certifications to ensure compliance with regulatory and payer requirements.
• Communicates status and needs with Credentialing Department leadership and other Erie teams.

Skills

Microsoft Office

Credentialing software

Data entry

Verbal communication

Independent work

Education

High School diploma

Certified Professional Credentialing Specialist

Bachelor's degree

Tools

Credentialing databases

Credentialing software

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 escalate 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 & ResponsibilitiesUniformly 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.EducationRequired:High School diploma or equivalent required.Preferred:Certified Professional Credentialing Specialist by National Association of Medical Staff ServicesBachelor’s degree a plusExperienceRequired:Two years of current work experience in Credentialing.Preferred:Experience in applying privileging criteria a plus.Skills and KnowledgeRequired:Basic computer skills including Microsoft Office and credentialing software and databasesAbility to work independently without constant oversight, set work priorities, determine goals and strategies to achieve themCultural competency to work with a diverse practitioner populationAbility to communicate properly and effectively in verbal and written form with various levels of practitioners, hiring managers, and senior provider leadersApply knowledge, expertise, sound judgment, and other resources as necessary to generate and evaluate solutions and recommendationsAbility to consistently apply the state, federal and accrediting standards for credentialing and privilegingAbility to understand clinical competence as related to privileging criteria and evaluation tools and techniques used for demonstrating competenceAbility to adapt behavior in response to new information, changing circumstances and performance improvement conceptsPreferred:Intermediate proficiency in Microsoft Office a plus.Advanced credentialing software and database skills are a plus.The Erie Advantage PledgeWORKING TOGETHER FOR WHAT MATTERS MOSTErie makes a pledge that all current and future employees can feel confident that: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.