CVS Credentialing Coordinator

Schedule Details/Additional Information:

100% remote position, 40 hours per week, 1st shift

• 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.
• 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.

• Credentialing Specialist, Certified Provider (CPCS) issued by the National Association Medical Staff Services (NAMSS).

• High School Graduate.

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

• 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.

• Exposed to a normal office environment.
• Operates all equipment necessary to perform the job.

Pay Range

Our Commitment to You:

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, and Short- 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

About Advocate Health

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.