Medical Staff Services Professional

Credentialing Verification Specialist

Conducts credentialing verification activities on behalf of Spectrum Health Hospitals in accordance with departmental procedures and the standards of The Joint Commission and the National Committee for Quality Assurance (NCQA) and other state and federal regulatory bodies. Provides guidance to less experienced coordinators in carrying out CVO processes.

Essential Functions:

• Provides guidance and support to other coordinators for front line questions and problem solving. Plans and oversees the provider reappointment process consistent with CVO policy. Assists manager with audit responsibilities as assigned.
• Initiates and supports the provider application process by sending, receiving, and analyzing provider documents and data import to determine completeness in preparation for the credentials verification process.
• Responsible for gathering, verifying and evaluating highly confidential and sensitive health care provider credentials consistent with departmental guidelines and accreditation standards.
• Efficiently performs all aspects of credentialing verification, including appointment and reappointment to ensure current credentials and timely handoff of provider files.
• Responsible for accurate data entry to ensure the integrity of credentialing information in applicable database(s).
• Collaborates with Participating Medical Staff Offices (PMSO's) to problem solve and facilitate the smooth handoff of files during the credentialing process.
• Uses critical thinking skills to conduct follow-up with individual providers and internal and external entities to resolve discrepancies identified during the credentialing process.
• Actively participates in team meetings and continuously evaluates processes to identify opportunities for improvement of work product quality and efficiency.

Qualifications:

Required:

• High School Diploma or equivalent
• 5 years of relevant experience in a hospital, clinic, physician or professional payer credentialing office

Preferred:

• Bachelor's Degree

About Corewell Health:

As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.

How Corewell Health cares for you:

• Comprehensive benefits package to meet your financial, health, and work/life balance goals.
• On-demand pay program powered by Payactiv.
• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
• Optional identity theft protection, home and auto insurance, pet insurance.
• Traditional and Roth retirement options with service contribution and match savings.

Primary Location:

SITE - Butterworth Hospital - 100 Michigan St - Grand Rapids

Department Name: Med Affairs - Medical Staff Office - GR

Employment Type: Part time

Shift: Variable (United States of America)

Weekly Scheduled Hours: 0.1

Hours of Work: Variable

Days Worked: Variable

Weekend Frequency: N/A

CURRENT COREWELL HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.

Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.

Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.

An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.

You may request assistance in completing the application process by calling 616.486.7447.