Job Information
MERCY HEALTH CORPORATION Credentialing Coordinator in JANESVILLE, Wisconsin
JOB REQUIREMENTS: Essential Duties and Responsibilities Maintains high quality, timely and accurate credentialing processes of medical and allied healthcare professionals based upon system policies and procedures. Assists in the credentialing process by entering, logging, scanning information into the system for initial appointments, reappointments, add-on applications and maintenance. Completes and ensures compliance and delivery of required information to all customers in a timely manner. Processes and maintains credentialing and recredentialing in accordance with Mercy policies and procedures, Joint Commission and NCQA standards, and State and Federal regulatory guidelines. Ensures that all credentials are current and complete pursuant to expiration date of medical licensure, board certification, professional liability insurance coverage, DEA and other pertinent information per Mercy policy/procedure. Monitors collection of all information received. Follow-up on missing items/documentation/incomplete forms. Submits follow- up requests, as needed. Identifies and evaluates potential red flags and works in collaboration with practitioner(s) to document the issue and practitioner response. Advises team lead and/or manager of questionable information received and any issues identified during processes. Submits closed files for audit/final review and secures missing items as identified by audit/final review. Maintains all credentials files to ensure that all correspondence is accurately filed; is knowledgeable and current in regard to process and legal/regulatory requirements. Maintains compliance with Mercy policies/procedures, federal, state and all accrediting agencies as required. Responds to verification, case log, and proof of malpractice coverage requests from hospitals and managed care organizations. Works with agencies and practitioners to assemble credentials files and arranges for review and secures signatures for locum tenens privileges. Responsible for taking credentialing files through full approval process, from Credentials Committee to Medical Executive Committee, through the Board Action Report. Schedules and secures rooms for Medical Staff meetings, sends out notices, drafts agenda, assembles meeting materials, drafts minutes and follow-up correspondence. Maintains practitioner information in credentialing software platform Culture of Excellence Behavior Expectations To perform the job successfully, an individual should demonstrate the following behavior expectations: Quality - Follows policies and procedures; adapts to and manages changes in the environment; Demonstrates accuracy and thoroughness giving attention to details; Looks for ways to improve and promote quality; Applies feedback to improve performance; Manages time and prioritizes effectively to... For full info follow application link. EOE&AA/M/F/Vet/Disabled. Mercy is an equal employment opportunity employer functioning under Affirmative Action Plans. ***** APPLICATION INSTRUCTIONS: Apply Online: ipc.us/t/FE96C008E8654EDE