Note: The job is a remote job and is open to candidates in USA. Mercy Health is a healthcare organization dedicated to helping patients and providing high-quality care to its communities. The Credentialing Specialist facilitates provider application processing, data collection, primary source verification, and onboarding and offboarding for the Credentials Verification Organization. The role maintains accurate provider records, ensures regulatory compliance, resolves discrepancies, and supports credentialing reviews while providing professional and confidential service.
Responsibilities
• Follows a standardized comprehensive credentialing application and data collection, application processing, and primary source verification processes that comply with all applicable regulatory standards
• Executes credentialing application and data collection, application processing, primary source verification for all new applicants and applicants for re-credentialing. Assures applications are correct, complete, resolves discrepancies in compliance with all applicable regulatory standards
• Assures files and documents are ready for Medical Director review, including all Credential Committees and Medical Staff Office (MSO). Works with the credentialing auditors to correct any deficiencies
• Organizes and maintains provider data and files. Processes applications timely and ensures that quality benchmarks are met with regards to turnaround times, accuracy of information and other CVO and regulatory metrics
• Assures that provider database is maintained with new and updated accurate provider information
• Follows all regulatory requirements related to the primary source verification process for medical staff and managed care compliance
• Completes credentialing compliance check points to assure that files are ready for release
• Maintains awareness of The Joint Commission (TJC), National Committee for Quality Assurance (NCQA), Center for Medicare/Medicaid (CMS) and other regulatory compliance guidelines through the organization's CVO provided continuing education
• Demonstrates excellent professional communication skills while interacting with colleagues, customer relations and MSO representatives, and leadership to collect missing information or resolve issues
• Maintains a strong respect for privacy and confidentiality
Skills
• High School or GED (required)
• Certified Professional Medical Staff Management (CPMSM) or Certified Professional Credentials Specialist (CPCS) by National Association of Medical Staff Services (NAMSS) (preferred)
• Bachelor's Degree in Business, Healthcare or other related field (preferred)
• Master's Degree in Business, Healthcare or other related field (preferred)
• 1 year recent experience in medical staff services or CVO setting (preferred)
• CredentialStream Credentialing software (strongly preferred)
Benefits
• Competitive pay
• Incentives
• Referral bonuses
• 403(b) with employer contributions (when eligible)
• Medical, dental, vision, and prescription coverage
• HSA/FSA options
• Life insurance
• Mental health resources and discounts
• Paid time off
• Parental and FMLA leave
• Short- and long-term disability
• Backup care for children and elders
• Tuition assistance
• Professional development and continuing education support
Company Overview
• Mercy Health is a mission-driven, integrated healthcare organization. It was founded in 1985, and is headquartered in Cincinnati, Ohio, USA, with a workforce of 10001+ employees. Its website is http://www.mercy.com/.