Credentialing Specialist

About the position

The Credentialing Specialist at UnityPoint Health is a full-time position based in Rock Island, IL, responsible for the credentialing and privileging processes for new Medical Staff and Allied Health Professional Staff applications. This role involves managing reappointment applications and requests for new privileges for the Trinity Medical Center Medical Staff. The Credentialing Specialist plays a crucial role in ensuring that all Medical Staff files are processed and tracked in a timely manner, which includes conducting primary source verification, reviewing information, and performing additional research as necessary. In this position, the Credentialing Specialist serves as a liaison between various stakeholders, including providers, the physician hospital organization (PHO), System CVO staff, and regulatory agencies. The role requires a strong understanding of hospital credentialing processes and regulatory requirements from organizations such as TJC, NCQA, and CMS. The Credentialing Specialist must ensure that all credentialing activities comply with these standards and that all necessary documentation is accurate and complete before presenting it to the Credentials Committee and Medical Executive Committee for approval. UnityPoint Health emphasizes a culture of integrity and commitment to doing what is right for the communities they serve. The organization offers a competitive Total Rewards program that includes benefits such as 401(k) matching, paid time off, and tuition reimbursement, which are designed to meet the diverse needs of employees at various life stages. UnityPoint Health is also dedicated to fostering a diverse and inclusive workplace, ensuring that every employee's voice is heard and valued. The organization believes in providing support and development opportunities to enhance the employment experience and encourages community involvement as part of its core mission.

Responsibilities

• Initial and reappointment credentialing for delegated credentialing processes
• Send applications and record in SharePoint accordingly
• Input data into credentialing software and keep appropriately updated
• Prepare/Validate all privileging information is accurate and prepare for Credentials Committee discussion as well as Medical Executive Committee and local Board
• Discuss any privilege delineations with Credentialing Committee Chair and other appropriate personnel prior to the Credentialing meeting
• Assure required education for new privileges are met
• Create new privilege delineation forms in accordance to national standards
• Prepare packet for presentation at required approval meetings, obtain signatures
• Notify appropriate members on provider approval and suspensions
• Ensure collection of Medical Staff Fees and Dues
• Ensure life certifications are current
• Ensure all EKG providers have privileges
• Review terminations/notifications

Requirements

• High School Diploma or GED required
• Excellent communication skills both written and verbal
• Knowledge of hospital credentialing
• Knowledge of regulatory requirements from TJC, NCQA, CMS
• Minimum of 2 years of experience in a hospital/medical related role

Nice-to-haves

• Associates Degree preferred
• Database experience
• CPCS certified
• Valid driver's license when driving any vehicle for work-related reasons

Benefits

• Tuition reimbursement
• Paid time off
• 401(k) matching