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Group Health Cooperative of South Central Wisconsin. BETTER TOGETHER
Full time position with the opportunity to work hybrid after fully trained and based on the day's business needs.
Must reside in the Madison area to be available for on-site projects and meetings.
Healthcare credentialing experience or knowledge of credentialing strongly desired.
GHC-SCW is a quality driven cooperative built on collaboration, community involvement, innovation, and belonging. In dedication to the health and well-being of our employees, we offer a comprehensive benefits package that includes health and dental insurance, along with paid short-term disability, long-term disability, and life insurance. Additional benefits include a flexible spending account, employee assistance programs, tuition reimbursement, pet insurance, eyewear discounts, and more.
Check us out by clicking on Many Talents, One Mission! The Benefits of Working at GHC-SCW.
POSITION SUMMARY
The Healthcare Credentialing and Medical Staff Administrator is responsible for a variety of activities related to health insurance plan credentialing for the GHC-SCW network facilities and providers, credentialing of GHC-SCW employed providers for outside facilities and health plans, monitoring delegated credentialing arrangements, coordinating the Peer Review and Credentialing Committee, acting as a liaison between GHC-SCW employed providers and medical malpractice vendors, acting as a liaison between GHC-SCW employed providers and outside legal requests (depositions, etc) and coordinating student and medical learner placements in the GHC-SCW Medical Division.
The Healthcare Credentialing and Medical Staff Administrator provides coordination, communication, and support to other key leaders and functions within GHC-SCW, such as NCQA accreditation, contracting, and GHC-SCW employed provider on/offboarding. The Healthcare Credentialing and Medical Staff Administrator works under the direction, guidance, and supervision of the Chief Medical Officer.
JOB SPECIFIC MINIMUM QUALIFICATIONS
1. Bachelor's degree from an accredited college or university in business, health care administration or relevant field is required, or equivalent combination of education and relevant experience.
2. Minimum one (1) year experience performing healthcare credentialing functions preferred. Minimum of three (3) to five (5) years' experience working in an administrative support position, customer service or related duties. Experience in a medical setting is required.
3. Certification as a Certified Provider Credentialing Specialist (CPCS) with the National Association of Medical Staff Services (NAMSS) preferred but not required.
4. Knowledge of or ability to learn National Committee for Quality Assurance (NCQA) and/or Joint Commission on Health Care Organizations (JCHCO) standards preferred.
5. Knowledge of and familiarity with medical terminology required.
6. Knowledge of and high level of proficiency in the use of Microsoft Office applications including Word, Outlook, Excel and PowerPoint is required. Knowledge of and/or ability to learn and use computer based applications/software such as electronic time and attendance systems. Ability to use the Internet to obtain information and conduct research.
7. Ability to provide guidance, supervision, and direction to subordinate staff. Leadership skills and collaboration skills are required.
8. Outstanding written and verbal communication skills required. Good verbal communication skills to provide telephone support required.
9. Good interpersonal skills necessary to deal courteously and effectively with members and staff are required. Excellent customer service abilities required. Ability to be culturally sensitive and to work with a diverse community. Ability to work as a part of a team and collaborate with others to accomplish goals.
10. Professional manner necessary to deal courteously and effectively with other staff and with the public required.
11. Ability to be appropriately professional in dealing with providers and providers.
12. Strong organizational skills, including ability to prioritize, manage multiple tasks and solve problems required. Ability to work within tight deadlines.
13. Ability to work with minimal supervision required. Ability to be flexible and adaptable to changing priorities and assignments. Must be procedure oriented. Ability to pay close attention to details and strive for 100% accuracy.
14. Ability to maintain strict confidentiality regarding company information, staff and patients required. Knowledge of or ability to learn HIPAA requirements.
15. Ability to use a keyboard extensively required. Fine manual dexterity required.
16. Ability to work occasional evening and weekend hours as well as overtime required.
The incumbent knows and abides by all Group Health Cooperative of South Central Wisconsin (GHC-SCW) organizational and departmental policies, sets personal standards and strives for high quality work in completing assignments, performs job duties in a timely manner, and represents the organization in a positive manner. The incumbent understands our Mission, Vision, and Common Values (stated below) and is committed to promote these values in behavior and attitude.
Our Mission Statement:
We partner with members and the communities we serve to maximize health and well-being.
Our Vision:
As a local, not-for-profit, member-owned Cooperative, we are the most trusted resource for lifelong health and well-being in the communities we serve.
Our Values

• We are a not-for-profit Cooperative
• We are member-centered
• We are equitable and inclusive
• We are quality-driven
• We are innovative
• We are community involved

We believe:
Healthcare is a human right.
In treating all people with dignity and respect.
There is strength in diversity.
Equity celebrates our humanity.
We are better together.
Group Health Cooperative of South Central Wisconsin is proud to be an equal opportunity employer. GHC-SCW considers candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.