Credentialing Specialist

L

Louis A Weiss Memorial Medical Center, LLC

Credentialing Specialist

Chicago, IL
Full Time
Paid
  • Responsibilities

    Weiss Memorial Hospital has been serving Chicago’s North Side and surrounding communities providing excellent health care services for over 60 years. We are a 236-bed, Joint Commission-accredited facility providing a full range of health care services to meet the needs of our diverse community. We have grown to better serve our community to include more than 450 doctors representing 42 medical specialties and more than 800 employees, all committed to providing you with personalized care. We are looking for exceptional people who share our mission and values to join our team!

    JOB SUMMARY

    Reporting to the Manager of the Medical Staff Office, independent judgment processes all requests for the initial appointment to the medical staff from the pre-application process through the initial application. Independently manages all physician input into various hospital systems to include Med Series 4 (MS4) and Opus Physician Referral and works as liaison to the contracted physician referral service. Provides administration support to various medical staff officers and committees as well as to the Medical- Staff Office and the Manager of the Medical Staff Office.

    JOB QUALIFICATIONS

    • Experience credentialing physicians in a healthcare environment.
    • Qualified to become a Certified Provider Credentialing Specialist or Certified Professional in Medical Services Management.
    • Knowledge of medical terminology and ability for medical terminology transcription.
    • Knowledge/ability for computer use and operation. The ability to develop a working knowledge and an understanding of the Medical-Dental Staff Line computer system and be able to extract information as requested by various hospital departments for marketing and planning purposes.
    • A high level of organizational skills and the analytical ability to perform difficult data gathering, prepare and process documents and to maintain records; very proficient typing and secretarial skills.
    • A high level of interpersonal skills in order to communicate effectively with the Medical Staff and various levels of hospital staff and visitors.
    • The ability to maintain a very high level of confidentiality.

    JOB DUTIES

    • Coordinates and monitors the pre-application process to include distribution of the pre-application form and review of the form and curriculum vitae after completion to assure appropriateness for medical staff positions. Orients physicians and allied health staff applicants to the credentialing process, Medical Staff Bylaws and departmental rules and regulations.
    • Coordinates and monitors the new physician application process in accordance with JACHO standards, the Medical-Dental Staff Office Bylaws and internal policies; verifies all primary sources and gathers all required information for presentation to the department and medical staff credentials committees. Completes follow-up after approval at the Board of Trustees meeting.
    • Processes requests for temporary privileges, forwards appropriate paperwork to department chair, medical staff president and CEO and obtains the necessary approvals. Maintains up to date information on all new privileges and credentials.
    • Maintains hospital physician credentialing database from which various reports can be disseminated to other network departments as needed and requested. Maintains physician privileges, including maintenance of section/department privilege forms. Maintains MacNeal Intranet physician database, including current home and office information, contact information, physician vacation and coverage, group name and ID number information and practice and specialty group information. Maintains physician information on the National Practitioner Databank, and other internal databases (such as “doctor’s e-mail listing”) through data entry of physicians new to MacNeal medical staff and deletion of members who have resigned.
    • Maintains Hospital Med Series 4 (MS4) database with all physician input. Enters all new physicians and allied health staff into this database and maintains demographics, privileges, etc. for current staff. Processes resignations and LOA’s to inactivate in the system as well.
    • Acts as Liaison to Physician Referral Service. Distributes physician referral applications for participation in referral service, checks for accuracy and completeness and enters information into the OPUS referral service database for the Beryl contracted service. Maintains this database with all changes in pertinent physician information including inactivating physicians who have resigned or are on LOA in the medical staff.
    • Handles daily physician queries from insurance companies, HMO’s and other hospitals and facilities in a timely manner by facilitating completion by department chairs and others.
    • Coordinates the gathering and distribution of information for meetings of various Hospital committees to include the Ethics Committee, Informatics Committee, Lab Utilization Committee and the quarterly general Medical Staff meetings. Prepares agendas, records and transcribes minutes promptly and handles follow-up resulting from meetings.
    • Maintains medical staff quality assurance files and assures their confidentiality.
    • Provides administrative support to the Medical Staff Officers as required.
    • Completes a wide variety of typing tasks, including dictated physicians’ reports, memos and letters, which are often confidential in nature, through the use of a personal computer. May also take and transcribe shorthand and/or machine dictation. Prepares correspondence, memoranda and routine reports independently for signature by Medical Staff, including officers.
    • Maintains the library of credentialing information to assist and educate department chairs and credentials committees with new issues, credentialing problems, questions and decisions. Remains informed of developments in area of expertise by attending seminars and workshops, reading pertinent literature, etc. regarding developments relating to medical staff office procedures, including standards of the Joint Commission on Accreditation of Healthcare Organizations and helps assure medical staff office compliance. Functions as a liaison to other areas of MacNeal Hospital as resource for credentialing issues.
    • Receives and screens visitors and telephone calls and directs appropriately. Responds to requests from other healthcare institutions regarding status and privileging information of medical staff members.
    • Conforms to the established Standards of Behavior

    Weiss Memorial Hospital provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.