Remote Credentialing Specialist
Methodist Hospital-Peoria Area
Coordinates and provides credentialing services within the Hospital Medical Affairs Department. This role must also provide credentialing service in a timely manor while staying in compliance with all governing bodies.
****Only candidates with recent hospital and/or medical staff credentialing experience will be considered. Candidate must have recent or prior experience with Morrissey Credentialing Software (MSOW).
Please note that we cannot hire candidates for this remote position that resides in the following areas: California, Vermont, New York, Washington, Puerto Rico, Oregon or Washington, D.C.
Why UnityPoint Health?
Culture – At UnityPoint Health, you Come for a fulfilling career and experience a culture guided by uncompromising values and unwavering belief in doing what's right for the people we serve.
Benefits – Our competitive Total Rewards program offers benefits options like 401K match, paid time off and education assistance that align with your needs and priorities, no matter what life stage you’re in.
Diversity, Equity and Inclusion Commitment – We’re committed to ensuring you have a voice that is heard regardless of role, race, gender, religion, or sexual orientation.
Development – We believe equipping you with support and development opportunities is an essential part of delivering a remarkable employment experience.
Community Involvement – Be an essential part of our core purpose—to improve the health of the people and communities we serve.
Visit us at UnityPoint.org/careers to hear more from our team members about why UnityPoint Health is a great place to work. [ Link removed ] - Click here to apply to Remote Credentialing Specialist
% of Time
Process initial and/or reappointment provider applications and conduct primary source verification and compliance with The Joint Commission, NCQA, CMS standards, State and Federal laws and in accordance with the medical staff bylaws.
• Supports the Coordinator(s) in providing assistance for applications for physicians and dentists requesting appointment to the medical and dental staff, which includes multiple contacts for verifying the information, submitted in the application.
• Supports the Coordinator(s) in providing assistance for reappointment for one-half of the Medical and Dental Staff annually for a two-year reappointment term which includes multiple contacts for verifying the information, submitted in the application.
• Processes applications for initial and/or reappointment might include:
• Determines the appropriateness of providing application materials to potential applicant based on established criteria.
• Reviews documents for completeness, current licensure, valid board certification and professional liability insurance in compliance with policies and procedures and standards.
• Verifies information that requires primary source verification.
• Obtains professional and peer references, as appropriate.
• Identifies any discrepancies between application and primary source verification.
• Creates a profile for all practitioners, including aggregate data and clinical competence.
• Organizes and completes credentialing assignments from the Coordinator(s) independently, efficiently, and in a timely manner.
• Maintains accurate attention to detail.
• Organizes and maintains credential files in order to facilitate retrieval and follow up with information that is readily accessible.
• Collects information from medical staff and participates in actions that ensure timely credentialing data collection.
• Processes an application within the established timelines as specified in relevant standards. Process request for temporary privileges to meet patient and clinical needs in accordance with applicable Joint Commission standards.
• Demonstrates initiative in organizing and prioritizing tasks, making for smooth workflow and positive, successful outcomes.
• Is able to meet urgent deadlines successfully, multi-tasks and works under pressure with many interruptions, but is able to complete projects or work tasks successfully.
• Assists in completion of outside Hospital verification requests in a timely manner.
• Monitor and update expiable so that all providers are current with physical or electronic copy on file.
• Assists with notifying practitioner and others of the governing body final decision of membership status or privileges to ensure proper documentation and communication regarding decision.
Screens telephone calls and visitors, and resolves routine and some complex inquiries, if possible, or routes to Director or Coordinator(s) for timely resolution.
• Puts forth a friendly, helpful manner to all contacts in the course of the workday.
• Shows good judgment in the screening process, getting priority messages to the appropriate individual in a timely manner.
• Conveys the details and essence of all messages.
• Demonstrates resourcefulness in resolving issues or inquiries. Does so in an independent manner.
• Anticipates needs, both defined and undefined, as evidenced by customer compliments, enhanced or newly developed processes that improve workflow, and effective communication.
• Demonstrates a well-developed ability to effectively communicate with medical and dental staff members and a wide range of people.
Performs ongoing data entry and maintenance of the Morrissey Credentialing Software (MSOW) utilizing all medical staff credentialing file information.
• Maintains strong knowledge of the latest technology in the MSOW Credentialing software.
• Administers and provides maintenance of the MSOW Credentialing Software database.
• Provides queries and reports to appropriate individuals from the MSOW Credentialing database.
• Tracks status of medical staff and allied health professionals in MSOW Credentialing database.
• Generates adaptable form letters from the MSOW Credentialing database to facilitate and assist in the credentialing and reappointment process.
• Enters all medical staff clinical privileges information into MSOW Credentialing database for on line viewing by appropriate need to know departments in the medical center.
• Verifies current IL licensure, IL controlled substance licenses from the IDPR website.
• Serves as a resource to others on the use of the various software functions.
• Conducts a file audit using the appropriate tools to ensure completeness of credentialing process.
Basic UPH Performance Criteria
• Demonstrates the UnityPoint Health Values and Standards of Behaviors as well as adheres to policies and procedures and safety guidelines.
• Demonstrates ability to meet business needs of department with regular, reliable attendance.
• Employee maintains current licenses and/or certifications required for the position.
• Practices and reflects knowledge of HIPAA, TJC, DNV, OSHA and other federal/state regulatory agencies guiding healthcare.
• Completes all annual education and competency requirements within the calendar year.
• Is knowledgeable of hospital and department compliance requirements for federally funded healthcare programs (e.g. Medicare and Medicaid) regarding fraud, waste and abuse. Brings any questions or concerns regarding compliance to the immediate attention of hospital administrative staff. Takes appropriate action on concerns reported by department staff related to compliance.
Identify items that are minimally required to perform the essential functions of this position.
Preferred or Specialized
Not required to perform the essential functions of the position.
Bachelor's degree in a medical, business, or related field
2-5 years of experience of secretarial experience including the demonstration of effective human relations and communication skills.
Certified Provider Credentialing Specialist
• Required English Skills
o Advanced reading skills
o Advanced writing skills
o Advanced oral skills
• Communication Skills
o Ability to respond appropriately to customer/co-worker
o Interaction with a wide variety of people
o Maintain confidential information
o Ability to communicate only the facts to recipients or to decline to reveal information
o Ability to project a professional, friendly, helpful demeanor
• Computer Skills
o Basic Skill
• Use of usual and customary equipment used to perform essential functions of the position.
• Work may occasionally require travel to other UPH facilities/hospitals.
• Required to drive your own vehicle for business purposes.
Requisition ID: 2023-127712
Street: 221 NE Glen Oak Ave
Name: 5020 UnityPoint Health Methodist Medical Center
FLSA Status: Non-Exempt
Scheduled Hours/Shift: Full-time, Monday-Friday, Day shift
External Company URL: [ Link removed ] - Click here to apply to Remote Credentialing Specialist