Remote Credential Evaluator Jobs (NOW HIRING)

• Full time, first shift

• Fully Remote Role from these states: AL, AK, AR, AZ, DE, FL, GA, IA, ID, IL, IN, LA, KS, KY, ME, MI, MO, MS, MT, NC, ND, NE, NH, NM, NV, OH, OK, PA, SC, SD, TN, TX, UT, VA, WI, WV, WY.

• Due to complex requirements, remote work is NOT permitted for short or long periods in: CA, CO, CT, HI, MA, MD, MN, NJ, NY, OR, RI, VT, WA and working Internationally (this includes working while on vacation).

• No relocation, No Sponsorship or transfer of visa for this position now or in the future.

Pay Range:

Coordinates credentials verification and analysis activities to support appointment, reappointment and other credentialing activities to the practitioners of the medical staff of all Advocate Aurora Health hospitals, surgical clinics and health network, and external customers.

Major Responsibilities:

• Evaluates requests for applications and obtains authorization as needed. Determines appropriate action to accept or deny application requests. Initiates application process.

• Processes applications, reappointments and other credentialing events to the Medical Staff/Network, assessing practitioner information to determine the presence of potentially adverse information and determines further action required. Responsible for quality control on the content and completeness of finalized practitioner credentials files for our clinical staff in Wisconsin and Illinois.

• Coordinates biennial review, ensuring each practitioner seeking reappointment is evaluated according to requirements by external accreditation and regulatory standards.

• Documents all work performed for credentialing events in database as part of the communication with internal customers.

• Communicates the progress, completion and findings of ongoing applications to leadership, and as appropriate to other customers. Identifies evolving issues of concern and takes appropriate action.

• Maintains credentialing database according to department policies and procedures and regulatory guidelines. Provides an electronic historical record of credentialing events within the organization.

• Responsible for investigation and documentation of practitioner credentials, utilizing specialized knowledge to obtain verification of all aspects of a practitioner's background, training and past practice. Understands credentialing requirements of both The Joint Commission and NCQA, CMS and other governmental requirements, and performs in accordance with these standards.

• Generates and maintains accurate documentation that may be reviewed and judged for acceptability by state and federal licensing agencies, external customers and may be called into a court of law to justify decision-making by Aurora entities. Manages external audits for delegated credentialing contracts, prepares and reviews files, transmits to delegate, demonstrates adherence to NCQA standards through individual credentialing records.

• Evaluates privilege requests to ensure that required supporting documentation named in privilege criteria is included.

• Deals with customer questions and complaints by Aurora Health Care caregivers, physicians, allied health practitioners and external agencies.

Licensure, Registration, and/or Certification:

• Credentialing Specialist, Certified Provider (CPCS) issued by the National Association Medical Staff Services (NAMSS) is preferred by not required.

Education Required:

• High School Graduate.

Experience Required:

• Typically requires 3 years of experience in physician credentialing, medical education, a hospital environment and/or health insurance.

Knowledge, Skills & Abilities Required:

• Excellent communication, organizational and problem-solving skills.

• Proficiency in the use of Microsoft Office (Excel, Access, PowerPoint and Word) and credentialing software.

• Ability to sit for extended periods.

• Ability to use a computer, enter data, and write for extended period.

• Ability to organize and professionally manage demanding workload.

• Demonstrated team player and self-motivated.

• Preferred knowledge of accrediting and regulatory agencies as related to the Medical Staff, including (but not limited to) Joint Commission, DNV, HFAP, CMS, OSHA, NCQA and State and Federal Law and other standards and regulations, and hospital and system-wide policies regarding licensed independent practitioners in the hospital setting required.

• Ability to work effectively and independently.

Preferred:

• MDStaff or other credentialling data base experience

• Exceptional attention to detail

• Exceptional verbal and written communication skills

Physical Requirements and Working Conditions:

• Exposed to a normal office environment.

• Operates all equipment necessary to perform the job.

#LI-Remote

#healthcare

#credentialling

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

Our CommitmenttoYou:

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more - so you can live fully at and away from work, including:

Compensation

• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training

• Premium pay such as shift, on call, and more based on a teammate's job

• Incentive pay for select positions

• Opportunity for annual increases based on performance

Benefits and more

• Paid Time Off programs

• Health and welfare benefits such as medical, dental, vision, life, andShort- and Long-Term Disability

• Flexible Spending Accounts for eligible health care and dependent care expenses

• Family benefits such as adoption assistance and paid parental leave

• Defined contribution retirement plans with employer match and other financial wellness programs

• Educational Assistance Program

Note: Eligibility for programs listed above may depend on your FTE or status (e.g., full-time, part-time, per diem, temporary, etc.); please ask a Recruiter for more information during an interview.