Credentialing Specialist (NOT A REMOTE POSITION)

The Credentialing Specialist is responsible for credentialing physicians, advanced practitioners, chiropractors, radiologists, anesthesiologists, physical therapists, and other clinic positions as appropriate. Responsible for assisting with professional license applications, hospital credentialing, Managed Care contract notifications, provider files for appointment and re-appointment to the Clinic's medical staff, and current certifications as outlined with the Clinic's by-laws.

Job Relationships
Reports to the Onboarding Manager

Principal Responsibilities

• Initiate, establish, and maintain physicians' files for employed Physicians, contracted Physicians, Nurse Practitioners, Physician Assistants, Chiropractors, Anesthesiologists, and Certified Registered Nurse Anesthetists.
• Provide credentialing for medical staff appointment for new Physicians, Chiropractors, Nurse Practitioners, Physician Assistants and Certified Registered Nurse Anesthetists which includes: completed State of Illinois Credentialing Form, the supporting documents (CV, licenses, MD diploma, residency & fellowship certificates, & board certifications), 3 personal references, primary source verification of schooling and data bank inquiry.
• Work with various directors so that appropriate documentation is complete and received to ensure credentialing and re-credentialing of physician is not delayed.
• Provide assistance in helping new physicians apply for hospital privileges, and change their licenses to correct address for DEA or other licenses.
• Provide assistance for physicians in re-appointment paperwork needed by all the area hospitals.
• Provide assistance for nursing home credentialing or re-credentialing paperwork for physicians.
• Complete and follow progress of all managed care credentialing applications and re-credentialing applications in a timely, efficient and professional manner.
• Work closely with managed care plans to maintain accuracy in physician directories.
• Initiate and maintain provider number on IDX.
• Work closely with Transition Team, making sure all appropriate paperwork is submitted to the managed care programs regarding a physician's departure. Any relocation of physician requires notification to all managed care programs with appropriate documentation. Provide assistance in helping the physician obtain correct licenses for relocation.
• Work closely with Patient Accounting department providing support regarding contract questions and other issues that arise. Keeping them updated when credentialing is complete for a physician, along with the effective date for the contract.
• Responsible for accuracy and accessibility of credentialing software.
• Comply with the Springfield Clinic incident reporting policy and procedures.
• Adhere to all OSHA and Springfield Clinic training & accomplishments as required per policy.
• Provide excellent customer service and adhere to Springfield Clinic's Code of Conduct and Ethics Standards.
• Perform other job duties as assigned.

Education/Experience

• Bachelor's degree in business or healthcare related studies preferred.
• Two (2) yrs healthcare experience required.
• Healthcare credentialing experience preferred.

Knowledge, Skills and Abilities

• Maturity and dependability essential.
• Ability to handle multiple projects simultaneously assesses priorities and function well under stress with many interruptions.
• Ability to accept and implement change. Works with minimum of supervision. Must be self-motivated and able to make appropriate decisions and follow through.
• Knowledgeable in the use of various office machinery, including printers, typewriters, dictaphones, copiers, fax machines and various phone systems. Expertise in Microsoft Office necessary.
• Strong communication skills essential. Must be able to project a professional pleasant image. Observes high standards of confidentiality. Telephone mechanic/skills and etiquette essential.

Working Environment

• Office environment.
• Requires sitting for long periods of time.

PHI/Privacy Level
HIPAA4