The Broadlawns Medical Center campus includes an acute care hospital, primary and specialty care clinics, urgent care and emergency services, lab, radiology, dentistry, inpatient and outpatient mental health, crisis team, and community-based behavioral support services. Broadlawns accepts all forms of insurance and its approach to healthcare and quality outcomes earned a Level 3 rating from the National Committee for Quality Assurance, the highest achievable status for a medical delivery model.

We are a safety net hospital and our Patients are our North Star! With a dedicated staff of over 160 physicians and 1,600 employees, Broadlawns Medical Center ensures that our community has access to high quality healthcare that is coordinated, compassionate and cost-effective. We provide our employees a top-rated benefits package, supportive work culture, and more! 

Credentialing Specialist

The Credentialing Specialist position will report to the Vice President, Chief Physician Quality Officer and will be responsible for enhancing, coordinating, and supporting the credentialing process for the Providers of Broadlawns Medical Center. The Credentialing Specialist will organize, maintain, and verify all aspects of the process and maintain current files on Providers. They will possess an expert knowledge in both hospital and payor principles and practices of credentialing and privileging, to analyze, evaluate, and coordinate on all aspects of the credentialing process.

ROLES & RESPONSIBILITIES

Review, verify, and validate medical documentation, certifications, employment forms, testing, and other requirements to determine qualifications for credentialing and re-credentialing have been met and ensure compliance with company credentialing standards.Responsible for quality review of all aspects of the enterprise-wide credentialing function and primary source verification process for practitioners and health delivery organizations according to State and Federal regulations and Joint Commission requirements.Maintain contact with healthcare professionals to guide them through the required compliance documentation.Prepare correspondence and communications to obtain information determined to be deficient or missing as part of the application and primary source verification process.Accurately gather and input data into the system.Outreach to various medical specialty boards, educational institutions, or medical facilities to inquire about practitioner credentials, work history, or other findings related to determining credential qualifications.Conduct research on any issues determined to be red flags requiring attention of the Medical Director and review to ensure issue does not raise liability concerns for the company.Prepare correspondence to communicate with Providers on the status of applications, missing documentation, or follow up on requests for outstanding items.Facilitate problem-solving and suggest improvement processes to achieve customer resolution and elimination of current credentialing issues.Ensure that the BMC Provider Network consists of Providers that meet all regulatory and risk management criteria in order to minimize liability to the company and to maximize safety for members.Assist Providers with Council for Affordable Quality Healthcare (CAQH) website initiation, and ongoing support to ensure payor information is available and current, in addition to other payor entities that require information on Providers currently credentialed at Broadlawns Medical Center. Maintain timely records, entry, and response in electronic software system, Credential Streams. Support and embrace Diversity, Equity, and Inclusion initiatives.All other duties as assigned.

PERFORMANCE STANDARDS

Strong communication skills and ability to prepare and respond to correspondence in a timely manner.Outstanding organizational and time management skills.Ability to problem solve effectively and be very detail oriented.Strong research and analytical skills to research and identify information necessary to validate a Provider’s credentials.Ability to navigate between multiple databases quickly and accurately. Familiarity with Medical Licensure Board, Joint Commission on Accreditation and other entities used in the primary source verification of quality, education, and training of providers.Must have ability to work with mathematical concepts, health care acronyms, able to differentiate between Provider titles, download the Providers’ applications using the internet.

MINIMUM QUALIFICATIONS

Certified Provider Credentialing Specialty (CPCS) or equivalent working experience.Prior experience in any of the following: Provider enrollment, medical staff (hospital) or government contractor healthcare credentialing.3+ years of hands-on work within Medical Group or Health plan credentialing process.Familiarity with CAQH, Intellicred, or automated Credentialing Systems. Experience in a production or administrative role requiring self-direction and critical thinking.Extensive experience using a computer - specifically internet research, Microsoft Outlook and Word, and other software systems.Required knowledge of Centers for Medicaid/Medicare (CMS), National Committee for Quality Assurance (NCQA) and other credentialing regulations.

Work Shift

8a-4:30p (United States of America)

Benefits (FT/PT) 

Retirement - IPERS 

Education Assistance 

Employee Health & Wellness 

PTO 

Free Parking

Health Insurance 

Supplemental Insurance 

529 College Savings Plan 

And more! 

Broadlawns Medical Center is an Equal Opportunity Employer