Credentialing Auditor - Full Time - Mercy St. Anne Toledo

Mercy Health Toledo , OH 43601

Posted 2 months ago

Thank you for considering a career at Mercy Health

The Credentialing Auditor will provide operational oversight for the quality and audit function of all regional practitioner's credentialing and recredentialing files to ensure accuracy and completeness before review by Medical Staff Leaders and sending to the regional Medical Staff Offices. This position will act as the liaison between the Credentialing Office and Regional Medical Staff Offices and Medical Staff Leadership throughout the region. This quality-oriented product will provide rapid turn-around for both the practitioner and the facility in a cost-efficient manner while maintaining compliance with appropriate state and federal laws, regulatory agencies and medical staff bylaws/rules/regulations and policies.

ESSENTIAL FUNCTIONS

  • Audits 100% of credentialing and re-credentialing files submitted by the Credentialing Specialists for accuracy and completeness. This includes the auditing of data entry and scanning in the Credentialing Database as well as documentation submitted.

  • Returns audited files for corrections to the relevant Credentialing Specialist, for the purposes of data correction and education.

  • Prepares credentialing and re-credentialing files for electronic file review with Medical Staff Leaders and meets one-on-one with Metro Leaders, if requested.

  • Prepares Credentialing Report for the Regional Medical Staff Offices to include on their Committee Meeting Agendas and is available to participate in Credentials Committee meetings, if requested.

  • Develop, implement and maintain Credentialing audit tools annually to ensure compliance with current Joint Commission, State and Federal requirements.

  • Works closely with Regional Director to meet the educational needs of the Credentialing/Medical Staff Specialists and provides inservice/orientation/education as needed.

  • Assist with all regulatory, state and federal surveys, as requested.

MINIMUM EDUCATION

Required Minimum Education: 2 year/Associate's Degree

Preferred Education: Bachelor's Degree

LICENSURE/CERTIFICATIONS (must be non-expired/active unless otherwise stated):

Required: Certification by the National Association Medical Staff Services as either a CPCS or CPMSM or become certified within 3 years of employment.

Preferred:

Minimum Years and Type of Experience:

A minimum of at least 5 years experience in a central verification office, hospital or managed care setting.

Other Knowledge, Skills and Abilities Required:

Knowledge of the acute care/hospital credentialing proces, including initial appointment, privilege delineation and reappointment

Knowledge and experience in medical/legal issues and laws and regulatory requirements (TJC, CMS Conditions of Participation)

Strong computer skills including knowledge of Cactus software credentialing system

Strong organizational skills with required attention to detail; Ability to solve problems and resolve conflicts

Excellent oral and written communication skills

Excellent interpersonal skills and ability to work effectively and efficiently with others

Ability to work independently

Ability to maintain confidential information and exhibit a professional appearance and demeanor; ability to travel.

Other Knowledge, Skills and Abilities Preferred:

Proficiency with office software applications (e.g., Microsoft Office Suite), presentation skills and strong time management skills

Mercy Health is an equal opportunity employer.

We'll also reward your hard work with:

  • Comprehensive, affordable medical, dental and vision plans

  • Prescription drug coverage

  • Flexible spending accounts

  • Life insurance w/AD&D

  • An employer-matched 403(b) for those who qualify.

  • Paid time off

  • Educational Assistance

  • And much more

Scheduled Weekly Hours:

40

Work Shift:

Days (United States of America)

Department:

Credentialing

  • Toledo Regional

All applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability. If you'd like to view a copy of the affirmative action plan or policy statement for Mercy Health

  • Youngstown, Ohio or Bon Secours

  • Franklin, Virginia; Petersburg, Virginia; and Emporia, Virginia, which are Affirmative Action and Equal Opportunity Employer, please email recruitment@mercy.com. If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team at recruitment@mercy.com

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Credentialing Auditor - Full Time - Mercy St. Anne Toledo

Mercy Health