Credentialing Specialist, Lead

Hourly Pay Range:

Position Highlights:

• Position: Lead Credentialing Specialist
• Location: Naperville, IL
• Full Time: 40 hours
• Hours: Monday-Friday, 7:30a-4:00p
• Required Travel: To other Endeavor Locations

A Brief Overview:
The Credentials Specialist Lead provides training, coaching and support to the credentialing team of the CVO. Manages daily activities related to application and reappointment assignment, resolution of application issues with team and is the first line of problem resolution with complex issue management related to applications. Serves as a subject matter expert on Medicare Provider Enrollment, Chain, and Ownership System (PECOS), Illinois Medicaid Program Advanced Cloud Technology (IMPACT) and enrollment problem solving. Supports team with navigating MSOW system issues, compliance and policy questions related to sites, and managed care entities. This role also functions fully as a Credentials Specialist that processes applications and enrollment for 7000+ providers who request to be part of one or all the following: a hospital medical staff, be enrolled in a government health plans, belong to and IPA/PHO or to the Clinically Integrated Network (CIN) and require managed care credentialing and rostering to our contracted health plans. The specialist also processes reappointments for each provider which are processed every three years, and revalidation for CMS. Builds and maintains each provider's data profile, which feeds other enterprise-wide systems such as Workday, Data Warehouse and Epic. The CVO serves the entire system, and processes physicians, advanced practice professionals and other allied health professionals who are allowed to bill under state law and payor contracts.

What you will do:

• Trains, coaches, and supports the credentialing team while collaborating with the manager to develop and implement staff procedures, ensuring their consistent adoption and execution across the team.
• Assigns applications and reappointments daily to team, resolves issues with requestors/customers.
• Collaborates with the MSOW system administrator to test and optimize system processes and performance, troubleshooting alongside the technical support team to ensure seamless functionality aligns with credentialing workflows.
• Initial and reappointment application processing utilizing credentialing software, verifies application elements according to Endeavor health policies, regulatory standards (TJC, CMS..), state and federal laws and third party payor contracts.
• Critically reviews provider data and verification results to identify any red flags, privilege request issues, and any other application issues and communicates with key stakeholders (HR, hiring managers, practice managers, Chairman and Division Heads) to resolve prior to releasing to the site/requestor.
• Enroll, revalidate, and modify billing providers in government plans (PECOS/IMPACT) and input/update data as appropriate to assure successful enrollment and retention of providers for revenue cycle.
• Collaborate with network management to assure plan data is accurate and provider verification is sent to the organization's physician partners for review and approval.

What you will need

• High School Required
• 4 Years Credentialing experience preferred.
• Ability to teach, and coach team members.
• Ability to be objective and diplomatic with team to problem solve.
• Ability to make administrative/procedural decisions and judgements.
• Ability to investigate and analyze information and draw conclusions.
• Ability to process computer data, format and generate reports.
• Ability to communicate effectively, both orally and in writing.
• Ability to foster a cooperative working environment.
• Ability to participate positively in a team environment.
• Ability to multitask, manage multiple priories, customers, and deadlines.
• Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community.
• Knowledge of PECOS provider enrollment for Medicare.
• Knowledge of facility enrollment for Medicare (done by leads only).
• Knowledge of Medicare Railroad enrollment system under Palmetto GBA.
• Knowledge of IMPACT enrollment system for IL Medicaid.
• Knowledge of MSOW Credentialing Software and Reporting.
• Knowledge of standards and rules for ABMS Board Certification.
• Knowledge of related accreditation and regulatory certification requirements: TJC, CMS, DNV, ACHC.
• Knowledge of medical credentialing, provider privileging and standards.
• Knowledge of Bylaws, policies and regulations of Endeavor hospitals and legal environment in which they operate.
• Certified Provider Credentialing Specialist (CPCS) - National Association Medical Staff Services (NAMSS) Required

Benefits (for full and part time positions):

• Premium pay for eligible employees
• Career Pathways to Promote Professional Growth and Development
• Various Medical, Dental, and Vision options
• Tuition Reimbursement
• Free Parking at designated locations
• Wellness Program Savings Plan
• Health Savings Account Options
• Retirement Options with Company Match
• Paid Time Off
• Community Involvement Opportunities

Endeavor Health is a fully integrated healthcare delivery system committed to providing access to quality, vibrant, community-connected care, serving an area of more than 4.2 million residents across six northeast Illinois counties. Our more than 25,000 team members and more than 6,000 physicians aim to deliver transformative patient experiences and expert care close to home across more than 300 ambulatory locations and eight acute care hospitals - Edward (Naperville), Elmhurst, Evanston, Glenbrook (Glenview), Highland Park, Northwest Community (Arlington Heights) Skokie and Swedish (Chicago) - all recognized as Magnet hospitals for nursing excellence. For more information, visit www.endeavorhealth.org.

When you work for Endeavor Health, you will be part of an organization that encourages its employees to achieve career goals and maximize their professional potential.

Please explore our website (www.endeavorhealth.org) to better understand how Endeavor Health delivers on its mission to "help everyone in our communities be their best".

Endeavor Health is committed to working with and providing reasonable accommodation to individuals with disabilities. Please refer to the main career page for more information.

Diversity, equity and inclusion is at the core of who we are; being there for our patients and each other with compassion, respect and empathy. We believe that our strength resides in our differences and in connecting our best to provide community-connected healthcare for all.

EOE: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor.