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credentialing Specialist CVS

Requisition ID: 30642
Location: Dempster Corporate
Location Address:
5747 West Dempster, Morton Grove, 117015 60053 United States (US)
Daily Hours: 8
Standard Hours: 40
Employment Status: Full-time
Employment Type: Regular
Shift: Day
FLSA: N
SUMMARY
The Credentialing Specialist is under the leadership of the Credentialing Manager and may also receive direction from the System Director of Medical Staff Services and Regulatory. Supports hospital credentialing and managed care credentialing processes, including but not limited to, primary source verifications. Works efficiently and effectively in accordance with established regulatory agencies, accreditation organizations, Managed Care Organizations, Presence Health Partners, Medical Staff Bylaws, CVS policies and procedures, Hospital and Medical Staff policies for initial applicants and re-applicants.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Is responsible for coordinating the initial and re-credentialing primary source verification process for all facilities of Presence Health that agree to engage the Central Verification Services Department to render primary source verification services or the Presence Health (PH) System for delegated credentialing.
Primary Source Verification and Monitoring
Primarily responsible for reappointment applications. Supports the primary source verification process for initial applications. This function includes processing of all primary source queries.
Performs timely monthly monitors and reviews of practitioners' related credentialing expirations such as licenses, DEA/CSL, certificates and certificates of insurance.
Duties include the gathering, verification and evaluation of healthcare practitioner and/or provider credentials.
Works closely with Credentialing Coordinator to assure completeness, accuracy and timely processing of an application or reappointment for Medical Staff membership, Allied Health privileging, or delegated credentialing.
Monitors, analyzes and tracks responses for accuracy and quality of information received, determines and pursues additional investigation, as required, thus enabling the PH facilities to make informed decisions regarding appointments and reappointments.
QUALIFICATIONS
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and/or Experience
High school diploma or general education degree (GED) required; college certificate or degree preferred. 1-2 years' experience in healthcare, credentialing/medical staff office, or managed care credentialing experience preferred.
Detailed oriented, organized with strong sense of ownership and responsibility. Must have ability to use independent judgment to manage and prioritize the multiple tasks and deadlines in a professional and positive manner. Attention to details required.
Computer Skills
Intermediate to advanced PC skills: Web proficiency / internet; database management; MSWord required. Experience in MD-Staff or Morrisey databases, MSExcel and MSAccess preferred.
#LI-MR1 0
Business Unit: Corporate (LRHC and LPH)
COMPANY OVERVIEW:
EOE of Minorities/Females/Vets/Disability
Nearest Major Market: Chicago
Job Segment: Medical, Law, Database, Healthcare, Legal, Technology

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