Credentialing Specialist, Clinical Staff Office

The Clinical Staff Office at UI Health Care has an opening for a full-time Credentialing Specialist.  Under general supervision, the Credentialing Specialist performs hospital privileging, managed care credentialing and verification activities by examining and evaluating data according to established guidelines, requiring a knowledge of rules, criterion and accreditation standards and UIHC Bylaws, Rules & Regulations. These duties impact the provision of patient care by practitioners at UI Health Care, as well as outreach clinics, external clients and managed care payors.

The Clinical Staff Office (CSO) provides Credentialing Verification Organization services for UI Health Care, Stead Family Children’s Hospital, and numerous UI Health Care Outreach clinics, external clients, managed care payers, State agencies, Colleges, and Student Health Centers (both in-state and out-of-state).  This includes obtaining and authenticating sensitive information and interpreting numerous sets of accrediting bodies’ standards and UI Health Care Bylaws, Rules & Regulations.  Direct patient care practitioners are delineated privileges by the UI Health Care Clinical Systems Committee, and are not able to see, touch, or bill for patient services until these credentialing and verification processes have been completed in full. 

The successful candidate must be highly organized, have strong communication skills, a high level of technical computer expertise, excellent customer service skills, be a team player and be willing to go the extra mile to assure all functions are completed in timely and professional manner. Must be able to manage multiple priorities and have strong problem-solving and critical decision-making skills.

Functional supervision is received from the Credentialing Supervisors and the Director of the Clinical Staff Office.

CHARACTERISTIC DUTIES AND RESPONSIBILITIES (may include some or all of the following): 

• Examines, evaluates and verifies documents such as reports, applications, records, checks and vouchers, etc. for completeness and accuracy, determining conformity to established guidelines and policies. Follows up on discrepancies and resolves problems.  Maintains appropriate files. 

• Investigates and analyzes data for accuracy while adhering to compliance standards of accrediting and regulatory bodies (i.e., Joint Commission, NCQA, URAC); prepares privileging packets for supervisors to review for committee submission; tracks and analyzes credentialing applications and materials with clinical department HR Representatives; identifies and follows-up on primary source verifications and pursues contact information for primary source verification.

• Enters data in a complex database that requires specialized subject matter knowledge.  Analyzes the data to maintain the database and generate reports.

• Supports daily credentialing operations of the office and clinical departments, including coordination of processes among colleagues, responding to routine and complex inquiries requiring judgement in the application of policies and procedures, and resolves issues concerning missing, questionable, or gaps in information to meet desired deadlines.

• Maintains working knowledge of UI Health Care Bylaws, UI Health Care credentialing policies and procedures, and CSO policies and procedures; translates knowledge into action regarding credentialing and privileging activities at the individual provider level.

• Initiates and processes standardized forms related to area of assignment.

• Conducts interim/ongoing monitoring of practitioner licenses, controlled substance certificates, insurance certificates, board certifications, CPR and other state/federal agencies on a weekly basis.

• Participates in