Credentialing Specialist at UW Health Northern Illinois – Rockford , Illinois

POSITION SUMMARY:

The Credentialing Specialist is responsible for the credentialing and privileging of UW Health Medical staff, advanced practice providers (APPs), StaffCorp and other outside entities. This position ensures these activities are conducted in compliance with the standards of the Joint Commission (TJC), the National Committee on Quality Assurance (NCQA,) ANCC Magnet, Illinois Department of Public Health (IDPH), Centers for Medicare and Medicaid Services (CMS) and the Bylaws and Rules and Regulations of UW Health. Also reviews medical and advanced practice applications in compliance with peer assessment of competence for physicians and providers applying or reapplying for affiliation with the UW Health, its affiliates or contracted entitles for which system provides credentialing services. Primary patient advocate. Provides initial review and analysis of membership and privileges and compliance of requirements as defined by each entity. Participates in continuous quality improvement activities and educational experiences in support of departmental philosophy and objectives, as well as Health System Initiatives.

EDUCATION/TRAINING:

High School diploma or equivalent. Bachelor’s degree in business or related field preferred.

At least two years of administrative experience office environment is required. Experience in medical staff office setting, provider enrollment, or in credentialing services environment preferred. Experience with medical staff credentialing and privileging process.

LICENSURE/CERTIFICATION:

Certification as a Certified Provider credentialing Specialist (CPCS) or ability to obtain certification according to NAMSS pre requisitions to obtain certification within 12 months of meeting eligibility requirements. Obtain/maintain certification according to the National Association of Medical Staff Services (NAMSS).

EXPERIENCE/SKILLS/ABILITIES:

• Knowledge of medical staff credentialing and privileging processes.
• Knowledge of The Joint Commission (TJC), National Commission of Quality Assurance (NCQA), and Center for Medicare Service standards (CMS), Illinois Department of Public Health (IDPH), Bylaws, rules, and regulations and how to apply them to medical staff processes.
• Exceptional oral and written communication skills.
• Ability to independently research issues and make effective recommendations using critical thinking skills.
• Effective analytical ability to solve complex problems and issues.
• Excellent customer service skills and ability convey a positive attitude to work with a diverse group of people.
• Demonstrated ability to function independently and as a team member, and consistently deliver quality outcomes.
• Ability to maintain the confidentiality of sensitive information.
• Excellent organizational skills and attention to detail.
• Knowledge of and comfort with credentialing software, ECHO preferred.
• Competent in Microsoft Outlook, Word, Excel, and PowerPoint.