Experience a rewarding and fulfilling career with Mercyhealth. Mercyhealth is committed to offering our partners a best place to work. Our unique workplace Culture of Excellence is built upon:
Employee engagement, empowerment and growth
Teamwork toward our common goal – providing exceptional health care services with a passion for making lives better
An atmosphere of caring and quality that cascades throughout the organization
Day shift, 80hrs/2wks
This position deals specifically with Payor Enrollment, not medical staff credentialing.
Essential duties and Responsibilities
The Supervisor will provide consistent, accurate and timely credentialing support, enhancing Mercy System’s ability to provide professional services, including timely and accurate verification, validation and documentation of the information provided by all applicants; ensures provider files are kept confidential at all times; develops, revises, and implements policies and procedures to maintain proper workflow and state-of-the-art practices; prepares activity reports, as requested; oversees daily operations which include staff development, interviewing, scheduling, supervising, training, evaluating and terminating staff; coordinates operations with other departments to ensure smooth workflow; assists with short-term and long-term goal setting. As appropriate, the Supervisor will provide consistent, accurate and timely enrollment support.
Responsible for accurate and complete data entry of credentialing or enrollment information into the credentialing database; works with database support staff to ensure updates are implemented; completes and analyzes verifications according to required standards and within required timeframes, including but not limited to medical licensure, board certification, professional liability insurance coverage, DEA and other pertinent information; summarizes provider information for peer review by the Credentials Committee; prepares for medical staff committee meetings including agenda and minutes; assists with pre-delegation and delegated audits related to credentialing; provides mentoring to staff members; performs internal audits on credentialing and re-credentialing files for accuracy and maintains compliance with credentialing policies and procedures; maintains knowledge of and compliance with TJC, NCQA, CAQH, and CMS standards, as appropriate; answers inquiries regarding credentialing status; handles provider correspondence as necessary to process applications; maintains required logs and prepares reports, as needed; identifies potential ‘red flags’ and works in collaboration with practitioner(s) to document the issues and practitioner response; reports questionable information received and any issues identified during processes to the director; completes closed file review and secures any/all missing items identified during review; responds to verification requests from hospitals, managed care organizations.
Oversees day to day operations of medical staff offices, oversees physician lounge, partner scheduling, and ordering supplies for offices. Assists under the direction of director in budgeting, resolving credentialing issues with third party payors, locum companies, and other third party organizations.
Other Skills and Abilities
Knowledge of credentialing guidelines by TJC (The Joint Commission), NCQA, CMS and CAQH; demonstrates working knowledge of healthcare and credentialing industry, including medico-legal issues and laws, regulatory agencies and other national standards; excellent professional telephone etiquette and communication skills.
Proactively prioritizes needs; shows attention to detail; communicates clearly and concisely; possesses excellent interpersonal & written communication skills including spelling, grammar and basic mathematical calculations.
Possesses effective presentation skills and works effectively in a team environment, showing respect for each person’s skills and knowledge. Establishes and maintains long-term customer relationships by building trust and respect; articulates knowledge and understanding of organizational policies, procedures, and systems; demonstrates proficiency in Microsoft Office (Word, Excel, Access) and other applications, as required; demonstrates knowledge of credentialing software (Cactus preferred) with completion of post-Cactus training testing of 90% or greater; maintains confidentiality of privileged information; knowledge of accepted practices related to primary source verification; drafting of policies/procedures for submission to director for review and approval.
Education and Experience
Bachelor’s degree preferred with a minimum of 5 years of experience in credentialing. Previous experience in a supervisory position preferred (healthcare facility, managed care setting, CVO or medical staff office).
CPMSM and CPCS required within 2 years.
Internal Number: 19740
Mercyhealth is a non-profit regional health care organization with more than 8,000 employee partners, 5 major hospitals, and 80 facilities and clinics throughout the Northern Illinois and Southern Wisconsin region. We are committed to being a top integrated health care provider and continuously work to make life better for the people, families and communities we serve.
Our partners serve with compassion, dedication, pride and professionalism. Our culture focuses on employee engagement, empowerment and growth, working together as a team to achieve one common goal: our mission of providing exceptional health care services, resulting in healing in the broadest sense and a best-in-class place to work for our partners.
We place great importance on providing our partners the tools, resources, facilities, and support to create lifelong career opportunities with an emphasis on a rewarding work-life balance. We achieve this by offering partners:
• Competitive compensation and benefits
• Tuition and certification reimbursement
• Generous PTO accruals
• Career ladder and advancement opportunities
• Partner recognition days and achievement awards
• Local/regional discounts and incen...tives
At Mercyhealth, we serve with a passion for making lives better, and we truly believe our accomplished staff is second to none in this mission. We hope you’ll consider becoming part of the Mercyhealth family.