Credentialing Specialist (Remote)Requisition R097225 Market Toledo, Ohio Department SS Clinical Operations - Credentialing Verification Shift Days Schedule Full-time
Thank you for considering a career at Bon Secours Mercy Health!
Under the direction of the CVO Credentialing Manager, carry out credentialing application/data collection, application processing, primary source verification processes of providers applying for medical staff privileges at a Mercy Health facility, on-boarding with Mercy Health Physicians, applying for participation in Mercy Health managed care contracts and government payers. Serves as a liaison and responds to any inquiries regarding the credentialing/re-credentialing process from physician practitioners, hospitals, outside agencies/institutions and other entities. In addition to medical professionals, this individual interacts with medical staff office(s), quality managements, practice managers, and other professionals as necessary to ensure the integrity of the credentialing data. The process is carried out in compliance with CVO credentialing policies and procedures and external regulatory agencies including but not limited to Joint Commission, National Committee on Quality Assurance (NCQA) and Ohio and Kentucky Departments of Health.
Assists with the development and implementation of comprehensive credentialing application/data collection, application processing, and primary source verification processes that comply with all applicable regulatory standards.
Facilitates and executes credentialing application/data collection, application processing, primary source verification for all new applicants and applicants for re-credentialing. Assures applications are correct, complete, resolves discrepancies. Assures files and documents are ready for CVO Medical Director review, CVO Credentials Committee and submission to Medical Staff offices and Payer Enrollment. Completes data entry and reviews for accuracy. Organizes and maintains provider data and files. Processes applications timely and ensures that quality benchmarks are met with regards to turnaround times and accuracy of information.
Assists with implementation of and assures provider database is maintained with new and updated provider information. Supports the Mercy Health on-boarding process and data needs. Assist other CVO team members with tasks and responsibilities as needed.
Interprets, explains and follows all regulatory requirements related to the primary source verification process.
Required Minimum Education:
- 2 yr Associates degree; specialty/major: Business / Management / Health Care
- Will consider experience in lieu of education
- Required: Working to obtain NAMSS CPCS or CPCSM certification in the next 2 years.
- Preferred: NAMSS CPCS or CPSCM Certification
- Minimum Years and Type of Experience: Two-three years of primary source verification experience.
- Other Knowledge, Skills and Abilities Required: Knowledge of primary source verification, NCQA, JC, State and Federal credentialing standards and requirements. Ability to manage time effectively. Willing and able to work remotely.
- Other Knowledge, Skills and Abilities Preferred: Associates degree in health care or related field.
Bon Secours Mercy Healthis an equal opportunity employer.
We’ll also reward your hard work with:
- Comprehensive, affordable medical, dental and vision plans
- Prescription drug coverage
- Flexible spending accounts
- Life insurance w/AD&D
- An employer-matched 403(b) for those who qualify
- Paid time off
- Educational Assistance
- And much more
Scheduled Weekly Hours:40
Department:SS Clinical Operations - Credentialing Verification
All applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability. If you’d like to view a copy of the affirmative action plan or policy statement for Mercy Health – Youngstown, Ohio or Bon Secours – Franklin, Virginia; Petersburg, Virginia; and Emporia, Virginia, which are Affirmative Action and Equal Opportunity Employers, please email email@example.com. If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team at firstname.lastname@example.org.
I wanted to get into a career where I’m happy to go to work.Luis F. Registered Nurse