PRN Senior Credentialing Specialist

Position Title:

Senior Credentialing Specialist-As needed

Shift: Days

• This is a PRN (as-needed) position intended to provide coverage based on departmental needs. There is no set weekly schedule or guaranteed number of hours. The selected candidate will be scheduled as needed to provide coverage for staffing needs, including planned or unexpected absences.

Compensation: $29/hr-$38/hr

The estimated range is the budgeted amount for this position. Final offers are based on various factors, including skill set, experience, location, qualifications and comparisons to colleagues in similar roles

Saint Anthony Hospital is a diverse and community-centric hospital, your career can thrive in, while addressing the health and wellness challenges that families in our neighborhood face. Our employees deliver on our mission and achieve success by working together to provide excellent customer service and patient care.

As part of Saint Anthony Hospital’s commitment to providing the highest quality health care, we will be building a new state-of-the-art hospital to serve as an anchor to the Focal Point Community Campus. Learn more at focalpointchicago.org.

Position

Purpose:

The Senior Credentialing Specialist is responsible for the coordination and administrative oversight of duties required for Saint Anthony PHO (PHO) participating provider credentialing and enrollment with managed care organizations (MCO) and provider organizations that are under contract through Saint Anthony PHO. Ensures the integrity of credentialing data and provides expertise and guidance to other credentialing associates.

Interacts extensively with physicians, MCO representatives, Saint Anthony medical staff services and clinical departments to facilitate physician enrollment and to maximize reimbursement for services rendered.

Facilitates the flow of information between medical staff departments, Saint Anthony PHO and Saint Anthony Hospital Administration.

This position exhibits knowledge of and follows the philosophy, mission, and vision of Saint Anthony Hospital. The incumbent demonstrates behavior consistent with the organization’s core values and standards of service.

• Complete and accurately submit provider MCO enrollment applications, spreadsheets, and letters to contracted MCOs
• Follow up with MCOs to ensure timely enrollment and participation of PHO providers, investigates credentialing denials and makes appropriate recommendations to correct
• Complete online the CAQH Pro View application and quarterly re-attestation for SAHA employed providers in a timely manner
• Resource for and aid providers and their office staff for completing MCO initial credentialing and re-credentialing documents
• Accurate data entry of all provider information and MCO participation status into the Credentialing Database
• Attend hospital Medical Staff Onboarding Meeting and provide timely updates regarding provider contracting status with the PHO and credentialing status with contracted MCOs
• Prepares and generates the monthly MCO Credentialing Status Report for Saint Anthony leadership and PHO Executive Committee Meeting that details at a minimum; par status by provider and MCO, CAQH attestation deadlines, credentialing application submission and acceptance dates, and missing credentialing information by provider.
• Prepare and generate a monthly report for the contracted medical billing company regarding the billing/credentialing status of employed physicians
• Notify contracted referral provider groups and management entity managing PHO risk-based contracts of PHO provider changes within the contracted timeframe that include; adds, demographic changes and terminations
• Prepare and send the Saint Anthony PHO Membership packet to providers who…