Med Staff/Credentialing Specialist

Michigan Medicine; Ann Arbor (MI); Hybrid; USD 64,000 - 90,000; Full time

Job summary

Michigan Medicine seeks a credentialing specialist to manage credentialing, recredentialing, license verification, and privileging with independent decision-making authority. You will ensure regulatory readiness by aligning with CMS, TJC, NCQA, ACHC, URAC standards and maintain data integrity across the provider systems.

The role requires meticulous evaluation of applications, primary source verification, and communication with clinical departments while supporting continuous improvement

Qualifications

• Bachelor's degree or equivalent combination of education and experience.
• Knowledge of accreditation and regulatory requirements for credentialing and privileging.
• 1-2 years experience in a credentialing role.
• Continuous Healthcare Improvement training within 3 months of hire.
• Demonstrated excellent interpersonal, problem-solving, and communication skills, both written and oral.
• Ability to make independent decisions on matters of significance using analytical skills and sound judgment.
• Excellent organizational and multi-tasking skills.
• Ability to work under pressure in a fast-paced environment, with strong time management skills.
• Demonstrated ability to work independently with a positive attitude.

Responsibilities

• Completes evaluation of applications to determine initial eligibility for membership/participation.
• Identifies red flags during credentialing and privileging with authority to halt the process and resolve issues.
• Conducts primary source verification for credentialing and privileging.
• Implements process improvement ideas using continuous improvement tools within regulatory requirements.
• Interprets and disseminates policies and procedures related to credentialing and recredentialing.
• Prepares credentialing records to affirm regulatory and accreditation readiness.
• Maintains confidentiality of credential information and protects data integrity across IT systems.
• Manages expirables such as licenses and certifications to maintain compliance.
• Presents complex credentialing information to clinical departments and stakeholders.
• Responds to inquiries and complaints with initiative, judgment, and customer-service orientation.

Skills

Interpersonal skills

Communication skills

Analytical thinking

Independent decision-making

Organizational skills

Time management

Ability to work under pressure

Independent work

Education

Bachelor's degree or equivalent

CPCS certification

Continuous Healthcare Improvement training

Job description

Mission Statement

Michigan Medicine improves the health of patients, populations and communities through excellence in education, patient care, community service, research and technology development, and through leadership activities in Michigan, nationally and internationally. Our mission is guided by our Strategic Principles and has three critical components; patient care, education and research that together enhance our contribution to society.

Job Summary

Provides a full range of professional services for credentialing, recredentialing, verifying licensing and certifications, monitoring sanctions, assessing competency, and processing privileging, as appropriate, by applying expert knowledge, expertise and experience. Acting as a specialist in the complex Michigan Medicine credentialing process has the authority to make independent decisions on matters of significance within the scope of responsibilities through analyzing, comparing, and evaluating various courses of action.

Responsibilities

Accountability for completion of initial appointment/reappointment, credentialing, and privileging following the strict requirements of Centers for Medicare and Medicaid (CMS), The Joint Commission (TJC), the National Committee for Quality Assurance (NCQA), Accreditation Commission for Health Care (ACHC), and Utilization Review and Accreditation Commission/American Accreditation Health Care Commission (URAC) to ensure the safety of our patients and safeguard Michigan Medicine against loss of accreditation, malpractice claims, and claims of negligent credentialing.

• Completes evaluation of application to determine applicant's initial eligibility for membership/participation. Analyze application and supporting documents for completeness.
• Identifies red flags during the credentialing and privileging process with authority to halt the process until the issue has been resolved, and is empowered, using strong analytical skills and judgment, to resolve locally or determine if the issue should be escalated. The credentialing specialist autonomously conducts the final analysis thoroughly before deeming the credentialing packet as complete and ready for committee review and board approval.
• Conducts all primary source verification necessary to complete the credentialing and privileging process, maintaining standards in accordance with policies and procedures, rules, regulations, and accreditation requirements. Through delegated credentialing contracts, the credentialing specialist completes this work on behalf of each contracted plan, leveraging the contracts to expedite enrollment and reimbursement.
• Using knowledge, creativity, and ingenuity, identifies and implements ideas for process improvement using continuous improvement tools and strategies, wherever possible, keeping within the confines of the rules, regulations, and accreditation requirements to develop a more efficient process while still providing a safeguard to the institution.
• Applies broad knowledge and ability in the interpretation and dissemination of policies, procedures, and processes/rules/regulations/law changes, concerning credentialing and recredentialing for practitioners at Michigan Medicine. Will act in an advisory capacity when questions or concerns about policies and procedures are raised.
• Ensure regulatory and accreditation readiness with contracted health plans, The Joint Commission, CMS, and the State of Michigan by preparing and analyzing credentialing records to affirm all requirements are met.
• Maintains the confidentiality of credential information, exercising caution and discretion in responding to inquiries for information.
• Maintains and protects the integrity of the credentialing database as the source of truth for privileged provider information throughout the AMC health system's various IT systems, such as the electronic health record, online provider directory, and billing system. Ensures database accuracy so that Provider Enrollment can complete health plan enrollment.
• Management and maintenance of expirables such licenses, certificates, and other credentials to maintain compliance with state law, policies, and procedures.
• Clearly and accurately presents complicated and thorough information regarding credentialing, recredentialing, and privileging to the clinical departments, providers, and institutional stakeholders.
• Responds to inquiries and complaints regarding matters of a sensitive or confidential nature, exercising initiative, independent judgment, and diplomacy, with an excellent customer service-oriented attitude.
• Duties as assigned.

Required Qualifications

• Bachelor's degree or equivalent combination of education and experience
• Knowledge of accreditation and regulatory requirements for credentialing and privileging.
• 1-2 years experience in a credentialing role.
• Continuous Healthcare Improvement training within 3 months of hire.
• Demonstrated excellent interpersonal, problem-solving, and communication skills, both written and oral.
• Ability to make independent decisions on matters of significance using analytical skills and sound judgment.
• Excellent organizational and multi-tasking skills.
• Ability to work effectively, cooperatively, and professionally with a diverse group of faculty and staff, and aid in the training and education of existing and new staff.
• Accurate and detail-oriented, along with the ability to oversee multiple tasks and priorities simultaneously with numerous interruptions.
• Must be able to work under pressure in a fast-paced environment, with strong time management skills.
• Demonstrated ability to work independently with a positive attitude.

Desired Qualifications

• 3-5 years of credentialing and privileging experience.
• CPCS certification.
• Extensive knowledge of credentialing and privileging.
• Knowledge of Hospital or clinical department policies and procedures.

Why Join Michigan Medicine?

Michigan Medicine is one of the largest health care complexes in the world and has been the site of many groundbreaking medical and technological advancements since the opening of the U-M Medical School in 1850. Michigan Medicine is comprised of over 30,000 employees and our vision is to attract, inspire, and develop outstanding people in medicine, sciences, and healthcare to become one of the world's most distinguished academic health systems. In some way, great or small, every person here helps to advance this world-class institution. Work at Michigan Medicine and become a victor for the greater good.

What Benefits can you Look Forward to?

• Excellent medical, dental and vision coverage effective on your very first day
• 2:1 Match on retirement savings

Modes of Work

Positions that are eligible for hybrid or mobile/remote work mode are at the discretion of the hiring department. Work agreements are reviewed annually at a minimum and are subject to change at any time, and for any reason, throughout the course of employment. Learn more about the work modes.

Background Screening

Michigan Medicine conducts background screening and pre-employment drug testing on job candidates upon acceptance of a contingent job offer and may use a third party administrator to conduct background screenings. Background screenings are performed in compliance with the Fair Credit Report Act. Pre-employment drug testing applies to all selected candidates, including new or additional faculty and staff appointments, as well as transfers from other U-M campuses.

Application Deadline

Job openings are posted for a minimum of seven calendar days. The review and selection process may begin as early as the eighth day after posting. This opening may be removed from posting boards and filled any time after the minimum posting period has ended.

U-M EEO Statement

The University of Michigan is an Equal Opportunity Employer. We are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants, including protected veterans and individuals with disabilities.