Team Lead, Credentialing - Janesville, United States - Mercy Health System

Description

Overview

• Credentialing Team Lead, Medical Staff, Days, 80 Hrs / 2 wks
• Location: Mercyhealth Trauma Center; Janesville, WI and Rockton Ave Campus; Rockford, IL.

The Credentialing Team Lead works as a liaison between Medical Staff Office management and partners, communicating policies, procedures and workflows, as well as providing training and monitoring work volumes.

Performs other duties as assigned.

Responsibilities

• The Team Lead will provide consistent, accurate and timely credentialing support, enhancing Mercy System's ability to provide professional services, including timely and accurate verification, validation and documentation of the information provided by all applicants; ensures provider files are kept confidential at all times; coordinates operations with other departments to ensure smooth workflow; assists with short-term and long-term goal setting.
• Assists with direct aspects of the credentialing and privileging processes for health care providers, including processing applications, verifying information, researching application details and ensuring processes are in accordance with medical staff bylaws.
• Assists with accurate and complete data entry of credentialing information into the credentialing database. Develop into database super user and work with database support staff to ensure updates are implemented.
• Responds to inquiries regarding credentialing status, handles provider correspondence as necessary to process applications, and maintains knowledge of and compliance with TJC, NCQA, CAQH, and CMS standards, as appropriate.
• Assists with the coordinator hiring process and training of new employees. Provides mentoring to staff members and assists with performance appraisals, disciplinary actions, and other HR relations.
• Audits and monitors all Medical Staff Office and Credentialing processes and individual partner performance to assure compliance with department policies and procedures; includes oversight and management of internal quarterly auditing to ensure compliance with external NCQA and CMS credentialing standards and for reporting to payers during annual delegated audits.
• Works in collaboration with the Quality department to coordinate all Credentialing Committee, Medical Executive Committee, and All Staff Meetings for all Mercy facilities.
• Reviews data and develops reports and other tools to identify areas for improvement and to set and track benchmarks and productivity based on industry standards; provides internal departments with needed reports on identified schedule or upon ad-hoc request.
• Assists in overseeing collaboration between Medical Staff Office, Enrollment, Quality, Provider Recruitment, Revenue Cycle, and Information Systems to ensure effective communication regarding new providers. Ensures timely communication with providers and operational leaders on status of applications.
• Works closely with leadership to problem solve situations appropriately and independently; proactively prioritizes needs; shows attention to detail; communicates clearly and concisely; possesses excellent interpersonal, presentation, and written communication skills.
• Ensures Department leadership is informed of any unusual and significant issues that may affect workflows related to the Medical Staff Office and Credentialing functions.
• Oversees day to day operations of medical staff offices including fielding partner inquiries, remote work partner scheduling, and ordering supplies for offices.
• Other duties and projects as assigned.

Education and Experience

Associates degree AND 3 years of experience in a healthcare-related environment, preferably with medical staff credentialing,

OR 5 years of experience working in a healthcare-related environment, preferably with medical staff credentialing required.

Bachelor's degree preferred.

Previous supervisory experience preferred.

Certification/Licensure

CPCS and CPMSM preferred or commitment to pursue certification within 3 years.

Special Physical Demands

The Special Physical Demands are considered Essential Job Functions of the position with or without reasonable accommodations.

This position is considered sedentary work exerting up to 15 pounds of force occasionally. Manual dexterity to operate a keyboard, telephone, fax, scanner and other office equipment as necessary to perform duties.

While performing the duties of this job, the employee is frequently required to sit; reach; use fingers to handle, finger and feel; and talk/hear.

Employee will occasionally stand; walk; and stoop/kneel/crouch/crawl.

Specific vision abilities required for this job include frequent close vision, distance vision, and ability to adjust focus with occasional color vision, peripheral vision and depth perception.

Repetitive finger/wrist movement associated with the use of a keyboard.

Culture of Excellence Behavior Expectations