Credentialing Coordinator Sr

Credentialing Specialist

Ann & Robert H. Lurie Children's Hospital of Chicago provides superior pediatric care in a setting that offers the latest benefits and innovations in medical technology, research and family-friendly design. As the largest pediatric provider in the region with a 140-year legacy of excellence, kids and their families are at the center of all we do. Ann & Robert H. Lurie Children's Hospital of Chicago is ranked in all 10 specialties by the U.S. News & World Report.

Location:

680 Lake Shore Drive

Minimum Qualifications

Required:

• BA preferred or minimum two years experience in credentialing and recredentialing process.
• Must be eligible for certification by National Association of Medical Staff Services as a Credentialing Specialist (CPCS).
• Must have experience with an NCQA audit.

General Understanding and Nature of the Position

Description:

Provides support to the FPP Managed Care Administrator of Management Services and Director of Credentialing in the above areas through primary source verification of information provided on the provider's application. Responsible for maintaining a credentialing process in accordance with NCQA and other State and Federal Regulatory Agencies. Processes and updates physician applications and sends completed applications to managed care contracted entities.

Responsible for helping to ensure compliance with NCQA, licensing and accrediting agency requirements.

Essential Job Functions:

• Manages credentialing and re-credentialing processes according to NCQA Standards, State and Federal guidelines, FPP Policies and Procedures, and FPP Bylaws.
• Coordinates materials for FPP Credentialing Committee; assists Director of Credentialing with FPP Credentialing and Recredentialing Policies and Procedures;
• Follows through with Credentialing Committee approvals;
• Adheres to State recredentialing cycles
• Responsible for credentialing and recredentialing for FPP clients;
  Responsible for the credentialing and recredentialing process for new and existing FPP physicians
• Develops billing invoices and calculates receivables for FPP clients;
• Responsible for FPP site visits;
  Medical Record reviews, and for querying National Practitioner Data Bank.
• Inputs data into FPP Credentialing database software and provide monthly querying of federal and state Medicare sanction databases
• Maintains physician portfolios and files and sends physician demographics, adds, terminations and changes to managed care payors electronically or by paper copy.
• Resolves issues regarding credentialing from payors, Lurie Children's staff and families via phone, fax or letter. Follows up with payors on any issues and reconciliations of payor rosters to ensure accuracy
• Reviews current regulatory standards to ensure compliance.
• Develops a credentialing training program for Office Coordinators; training Office Coordinators, Academic Office Coordinators, Point of Service and Managers regarding managed care credentialing.
• Coordinates malpractice verification with Risk Management; hospital verifications and credentialing eligibility with Practice Plan Administrators and Medical Staff Office;

Knowledge, Skills and Abilities:

• BA preferred or minimum two years experience in credentialing and recredentialing process.
• Certification/Licensure/Registration:
  Must be certified by National Association of Medical Staff Services as a Credentialing Specialist (CPCS).
• Must have experience with an NCQA audit.
• Data processing proficiency in Microsoft Excel and Access 97 or higher.
• Ability to work under pressure, be detail oriented, and have excellent cognitive and communication skills.

Pay Range: $21.00-$32.55 Hourly

At Lurie Children's, we are committed to competitive and fair compensation aligned with market rates and internal equity, reflecting individual contributions, experience, and expertise. The pay range for this job indicates minimum and maximum targets for the position. Ranges are regularly reviewed to stay aligned with market conditions. In addition to base salary, Lurie Children's offer a comprehensive rewards package that may include differentials for some hourly employees, leadership incentives for select roles, health and…