Credentialing Specialist

Requisition Number: 508319

Why North Memorial Health?

At North Memorial Health you will be a valuable member of our inclusive and nurturing team that values professional growth, offering big benefits like tuition reimbursement and a supportive culture with a world of education and training opportunities.

Our health system encompasses two hospital locations in Robbinsdale and Maple Grove as well as a network of 25 clinics which includes 13 primary clinics, 6 specialty clinics, 4 urgent care/urgency centers and emergency care offerings covering five counties. Our Robbinsdale Hospital, established in 1954, is a 385-bed facility recognized as the top Level 1 Trauma center for 25 years, as well as serving as a Level II pediatric trauma center, and Level III NICU. Our Maple Grove Hospital was established in 2009, is a 134-bed facility recognized as a top hospital in the state for Women and Children Care, with a Level III NICU, and is the largest Family Birth Center in the state (~5,000 deliveries per year and over 60,000 babies delivered). Both have been named to the 2022 Fortune/Merative 100 Top Hospitals list, 2023 Women's Choice Award Best Hospitals list.

Benefits the North Way!

As North Memorial Health is a non-profit organization you are eligible for the Public Student Loan Forgiveness program. Most part-time and all full-time positions are eligible for benefits.

• Adoption Reimbursement up to $3000 per child!
• Child Care Discount Program with New Horizon 10% off weekly childcare tuition!
• Education/Tuition Reimbursement
• 24/7 Fitness Center Access for all benefit eligible team members!

Commitment to Diversity, Equity & Inclusion

At North Memorial Health we recognize that the strength of our team lies in our diversity and make every effort to embrace the unique contributions and experiences of each person on our team. We strive to ensure that everyone feels like they are a valuable part of our community, with initiatives that reinforce our belief in diversity, equity, and inclusivity, to promote a workforce that enables authenticity, as we want to be our best when providing effective services to our patients. We acknowledge and celebrate the unique traditions, backgrounds, languages, beliefs, and customs of our community, and want everyone to feel welcome. Through our DE&I initiatives we hope to dispel myths, assumptions, and acts of implicit bias. Some of these initiatives include:

• Addressing system racism and inequities through our Safer Work Environment (Safer) initiative

• Use of pronoun badges and preferred names

• Encouraging cultural awareness through education and training

About this position

The Credentialing Specialist is responsible for ensuring that healthcare professionals are properly credentialed and compliant with all regulatory and organizational standards. This role involves verifying the qualifications, certifications, and licenses of healthcare providers, maintaining accurate records, and ensuring timely renewals. The Credentialing Specialist will have a strong understanding of credentialing processes, excellent organizational skills, and the ability to communicate effectively with various stakeholders. This position is critical to maintaining the integrity and quality of our healthcare services, ensuring that all providers meet the necessary standards to deliver safe and effective care. The Credentialing Specialist will work closely with healthcare providers and business stakeholders to ensure that all credentialing activities are completed accurately and efficiently.

• Serve as main point of contact for practitioners during the application process, providing timely updates and additional information as requested.

• Review credentialing applications and supporting documents for accuracy and completeness.

• Evaluate applications to determine eligibility for membership/privileges.

• Perform detailed and thorough review of credentialing/privileging requests and evidence of education, training, and experience to determine eligibility for requested privileges, membership, and/or plan participation.

• Perform primary source verification of the applicant's information.

• Recognize potential discrepancies and adverse information, and independently investigate and validate information across all available resources.

• Verify and document expirables using acceptable verification sources to ensure compliance with accreditation and regulatory standards.

• Obtain and assess information from various referral sources.

• Communicate findings and/or resulting actions to supervisor and department peers.

• Serve as main point of contact for external queries regarding an applicant's status, providing responses in a timely manner.

• Compile practitioner sanctions, complaints, and adverse data to ensure compliance.

• Demonstrate an understanding of state and regulatory standards.

• Facilitate efficient and cost-effective due process that complies with an organization's fair hearing and appeals policy as well as applicable legal and regulatory requirements.

• Maintain credentialing database continuously and consistently to ensure that accurate and current information is available to all stakeholders.

• Audit, assess, procure, implement, effectively utilize and maintain practitioner/provider credentialing processes and information systems (e.g., files, reports, minutes, databases) as outlined by the department.

• Securely manage information as the single source of truth by effectively navigating database software and maintaining data integrity.

• Accountable to demonstrate proficiency for the skills outlined in the appropriate position skills list.

• Maintain skill proficiency, including improvement where deemed necessary, and upgrading any additional or new skills on the appropriate position skills list.

Requirements

Education

• High School graduate or equivalent (i.e. GED) required.

Experience

• Two years' experience in medical credentialing, medical staff office, health plan enrollment, health plan contracting, or health care industry

• Knowledge of accreditation and regulatory standards, and other applicable regulations as they relate to credentialing and/or enrollment.

• Proficient in the use of all Microsoft Suite products

• Ability to work independently with minimal or no direct supervision.

• Detail-oriented, resourceful, self-starter and team player who works well alone or in a group.

• Independent problem solving and decision-making abilities.

• Ability to notice and address small but important details to ensure accuracy and completeness.

• Demonstrated ability to collaborate with managers, administrative staff as well as medical staff members and to interact with all levels of team members.

• Clear and professional communication, both written and verbal, while maintaining confidentiality.

• Exceptional customer service, interpersonal, organizational, business communication and time management skills.

• Effective planning, organizational and detail-oriented skills with ability to prioritize multiple projects and adjust workload accordingly.

Licensure/Certification

CPCS (Certified Provider Credentialing Specialist) or CPMSM (Certified Professional Medical Services Management) through the National Association of Medical Staff Services - Preferred

The North Memorial Health System is dedicated to building a diverse, inclusive, and authentic workplace, so if you're excited about this role, but your past experience doesn't perfectly align with every qualification listed, we encourage you to apply anyway. You may still be the right candidate for this or other roles.

Work Group: Non Contract

Hours per two week pay period: 80

Shift: Days 8 hours

Weekend Requirement: None

Call Requirement: None

Remote or On-site: Hybrid Remote

FLSA Status: Non-Exempt

Benefits: Yes