Specialist, Credentialing

Signature Health   Mentor, OH   Full-time
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Specialist, Credentialing 

Position is able to work remotely after training 

Must reside in the Greater Cleveland area

Are you looking for an organization where you can make a positive impact in people's lives? Our mission at Signature Health is to make behavioral health, primary care, infectious disease, case management services and more accessible to vulnerable patient populations of all ages across Northeast Ohio. As a non-profit community health center, our team of 800+ colleagues help individuals and families overcome mental health issues, recover from addiction, and improve their physical health.

If you share in our mission and are looking for an inclusive, compassionate and patient-focused agency, then Signature Health is the place for you!

In addition to a rewarding career, you will have access to the following benefits:

  • Highly attractive compensation package
  • Employer shared medical benefits, dental and vision
  • 401(k) with company match
  • Tuition & Professional Development Assistance
  • Generous paid time away from work (PTO)
  • Federal Loan Forgiveness Program (available on eligible on roles)
  • And much more!

Read below how you will contribute to putting good health within reach of all our community members and apply today! 

SCOPE OF ROLE

Reporting to the Chief Compliance Officer & General Counsel, the Specialist, Credentialing is responsible for leading, coordinating, monitoring, and maintaining the credentialing and re-credentialing process. Facilitates all aspects of Signature Health Inc. credentialing, including initial appointment, reappointment, certification expirations and renewals, as well as clinical privileging for Medical Staff, Health Professionals, and all other providers as needed.  Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws relating to credentialing. Responsible for the accuracy and integrity of the credentialing electronic system and related applications.  

HOW YOU’LL SUCCEED:

·         Leads, coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility.

·         Conducts thorough background investigation, research and primary source verification of all components of the application file.

·         Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.

·         Prepares credentials file for completion and presentation to the Board of Directors ensuring file completion within time periods specified.

·         Processes requests for privileges, ensuring compliance with criteria outlined in clinical privilege descriptions.

·         Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and privileging issues as they arise.

·         Assists with managed care delegated credentialing audits; conducts internal file audits.

·         Utilizes credentialing software, optimizing efficiency, and performs query, report and document generation; submits and retrieves National Practitioner Database reports in accordance with Health Care Quality Improvement Act.

·         Monitors the initial, reappointment and expirables process for all medical staff, professional staff, and delegated providers, ensuring compliance with regulatory bodies (Joint Commission, NCQA, URAC, CMS, CARF, HRSA, federal and state), as well as Medical Staff Bylaws, Rules and Regulations, policies and procedures, and delegated contracts.

·         Performs miscellaneous job-related duties as assigned. 

KNOWLEDGE & EXPERIENCE:

·         High school diploma or GED required; Associate’s/Bachelor’s degree preferred.

·         Minimum six (6) years of credentialing experience with four (4) years directly related to hospital medical staff or managed care credentialing.

·         NAMSS certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS) or actively seeking certification and ability to become certified within one year is preferred.

WORKING CONDITIONS:

·         Work is normally performed in a typical interior/office/clinical work environment.

·         While hours of operation are generally standard, flexibility to work evenings and extended hours may be required.

·         Requires periods of sitting, standing, telephone, and computer work. 

·         Hearing: adequate to hear clients or patients in person, over the telephone or through telehealth technology.

·         Speaking: adequate to speak to clients or patients in person, over the telephone or through telehealth technology.

·         Vision: Visual acuity adequate to perform job duties, including reading information from printed sources and computer screens.

·         Physical effort required: occasional lifting and carrying items weighing up to 15 pounds, unassisted.

·         Possible exposure to blood borne pathogens while performing job duties.

·         Frequent bending, reaching, and repetitive hand movements, standing, walking, squatting and sitting, with some lifting, pushing and pulling exerted regularly throughout a regular workday.

·         Sufficient dexterity to operate a PC and other office equipment.

 This Success Profile is not an exhaustive list of all functions or requirements that you may be required to perform; you may be required to perform other job-related assignments as requested by your supervisor or the company. You must be able to perform the essential functions of the position satisfactorily; however, if requested, reasonable accommodations may be made to enable you to perform the essential functions of this job, absent undue hardship. Signature Health may revise this Success Profile at any time, with or without advanced notice.

All employees of Signature Health are required to comply with the Signature Health Annual Influenza Vaccination Policy. This policy requires employees to obtain an annual flu vaccination. A medical and/or religious exemption may be submitted for review by the Signature Health Review Committee. Exemption requests are not guaranteed to be approved.

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This job is no longer available.

Signature Health

Mentor, OH