Credentialing Specialist

Hourly Pay Range:$24.86 - $37.29 - The hourly pay rate offered is determined by a candidate's expertise and years of experience, among other factors.Position Highlights:Position: Credentialing SpecialistLocation: Chicago, ILFull Time: 40 hours per weekHours: Monday-Friday, 7:30a-4:30pA Brief Overview:The Central Verification Office (CVO) Credentials Specialist processes applications and enrollment for 7000+ providers who request to be part of one or all the following: a hospital medical staff, be enrolled in a government health plans, belong to and IPA/PHO or to the Clinically Integrated Network (CIN) are require managed care credentialing and rostering to our contracted health plans. The specialist also processes reappointments for each provider which are processed every three years, and revalidation for CMS. Builds and maintains each provider's data profile, which feeds other enterprise-wide systems such as Workday, Data Warehouse and Epic. The CVO serves the entire Endeavor system, and processes physicians, advanced practice professionals and other allied health professionals who are allowed to bill under state law and payor contracts.What you will do:Processes initial and reappointment applications g utilizing credentialing software, verifies application elements according to Endeavor health policies, regulatory standards (TJC, CMS..), state and federal laws and third party payor contracts.Critically reviews provider data and verification results to identify any red flags, privilege request issues, and any other application issues and communicates with key stakeholders (HR, hiring managers, practice managers, Chairman and Division Heads) to resolve prior to releasing to the site/requestor.Enroll, revalidate, and modify billing providers in government plans (Medicare/Medicaid) and input/update data as appropriate to assure successful enrollment and retention of providers for revenue cycle.Collaborate with network management to assure plan data is accurate and provider verification is sent to Endeavor Health physician partners for review and approval.What you will need:High School Required2 Years credentialing experience preferred.Ability to make administrative/procedural decisions and judgements.Ability to investigate and analyze information and draw conclusions.Ability to process computer data, format and generate reports.Ability to communicate effectively, both orally and in writing.Ability to foster a cooperative working environment.Ability to participate positively in a team environment.Ability to multitask, manage multiple priories, customers, and deadlines.Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community.Knowledge of PECOS enrollment for MedicareKnowledge of Medicare Railroad enrollment system under Palmetto GBAKnowledge of IMPACT enrollment system for IL MedicaidKnowledge of MSOW Credentialing Software and ReportingKnowledge of standards and rules for ABMS Board CertificationKnowledge of related accreditation and regulatory certification requirements: TJC, CMS, DNV, ACHCKnowledge of medical credentialing, provider privileging and standards.Knowledge of Bylaws, policies and regulations of Endeavor hospitals and legal environment in which they operate.Certified Provider Credentials Specialist (CPCS) thru National Association Medical Staff Services (NAMSS) RequiredBenefits (for full and part-time positions):Premium pay for eligible employeesCareer Pathways to Promote Professional Growth and DevelopmentVarious Medical, Dental, and Vision optionsTuition ReimbursementFree Parking at designated locationsWellness Program Savings PlanHealth Savings Account OptionsRetirement Options with Company MatchPaid Time OffCommunity Involvement OpportunitiesEndeavor Health is a fully integrated healthcare delivery system committed to providing access to quality, vibrant, community-connected care, serving an area of more than 4.2 million residents across six northeast Illinois counties. Our more than 25,000 team members and more than 6,000 physicians aim to deliver transformative patient experiences and expert care close to home across more than 300 ambulatory locations and eight acute care hospitals – Edward (Naperville), Elmhurst, Evanston, Glenbrook (Glenview), Highland Park, Northwest Community (Arlington Heights) Skokie and Swedish (Chicago) – all recognized as Magnet hospitals for nursing excellence. For more information, visit you work for Endeavor Health, you will be part of an organization that encourages its employees to achieve career goals and maximize their professional potential.Please explore our website ( to better understand how Endeavor Health delivers on its mission to “help everyone in our communities be their best”.Endeavor Health is committed to working with and providing reasonable accommodation to individuals with disabilities. Please refer to the main career page for more information.At Endeavor Health, we are united by a shared commitment to working together to create a culture of connection and belonging—each of us bringing different skills and experiences as we deliver safe, seamless, and personal care. Every person, every time. We are committed to fostering an environment where all team members can be their best, learn, and pursue excellence together.EOE: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor. #J-18808-Ljbffr