Credentials Verification Specialist

Summary

Join Northwestern Medicine as a Credentialing Verification Specialist and play a vital role in ensuring the compliance and accuracy of healthcare practitioner credentials. You will initiate, verify, and maintain the confidential credentialing process for various healthcare professionals applying to Northwestern Medicine. Responsibilities include examining applications for completeness, performing primary source verification, and investigating discrepancies. You will also provide excellent customer service to applicants and internal staff. This position requires an Associate's degree and relevant experience or 4 years of experience in lieu of a degree. Northwestern Medicine offers competitive benefits.

Requirements

• Associate's degree plus 2 years of consecutive work experience in medical staff services or credentials verification; healthcare administration; or payor/managed care enrollment OR in lieu of degree must have 4 years of consecutive work experience in medical staff services or credentials verification; healthcare administration; or payor/managed care
• Strong knowledge of Microsoft Office products
• Excellent interpersonal, customer service, and communication skills (oral and written)

Responsibilities

• Initiate, verify, examine, and maintain the confidential credentials process for all professional applicants to NM (physicians, dentists, psychologists, advanced practice nurses, physician assistants, designated clinical fellows and ancillary providers as added from time to time to meet organizational needs and imperatives)
• Ensure compliance with all regulatory and NM established criteria that the applicant is able to practice in the state of Illinois (or other states as directed by NM) and at NM affiliates and that current, verified documentation is on file (licenses[s], malpractice liability insurance, board certification, etc.)
• Examine application for completeness and all required documentation. Examine information reported for missing data elements, timelines and time gaps. Identify as acceptable or adverse. Conduct follow-up with applicant on identified adverse elements. Investigate as necessary through to final resolution
• Perform primary source verification of all required credentials data elements and direct inquiries to all required data banks, profiling providers, licensing/regulatory agencies, etc. in compliance with all accreditation (JC, CMS, IDPH, NCQA), federal, state and NM requirements
• Examine and evaluate credentials information and results obtained by cross-referencing and comparing to information reported on application and curriculum vitae. Identify as acceptable or adverse. Examine for compliance with NM medical staff qualifications and criteria. Investigate discrepancies and misstatements with applicant and other primary sources as necessary through to final resolution. Identify key issues in core credentials data. Report identified adverse information and unresolved questions to CVO leads and/or Director as appropriate
• Determine when investigation and credentials process is complete by comparing and contrasting file to requirements and verifying that all documentation meets standards. Identify and flag time-sensitive items for reverification. Generate profile and reports
• Maintain accurate and current credentials database for all applicants. Record all credentials information immediately upon receipt. Monitor and track application status and credentials process. At all times, any department staff member must be able to access an applicant's electronic record and determine current status
• Maintain tracking documentation as per local standards to ensure continuity
• Provide first contact and customer service to professional applicants and credentialing staff. Communicate regularly to appraise of application status and/or any missing items
• Perform all essential functions (#s 2-6 having potential for high-risk exposure for the hospital) in compliance with all accreditation standards (JCAHO, NCQA), federal and state laws and regulations (IDFPR, IDPH, NPDB, etc.) and NM/medical staff bylaws and policies/procedures. Maintain knowledge base as applicable to credentialing

Preferred Qualifications

Bachelor's degree and 3-5 years credentialing experience

Benefits

• 401(k) matching
• Tuition reimbursement
• Loan forgiveness
• Lifecycle benefits