What are the responsibilities and job description for the Credentialing Specialist position at CommonSpirit Health?
Since 1885, CHI St. Alexius Health has been dedicated to leading health care in this region by enriching the lives of patients through the highest quality of care. We seek to continue our tradition of success and innovation with individuals dedicated to delivering the highest level of expertise and quality. Together we can continue to grow and support the legacy of CHI St. Alexius Health for many years to come.
CHI St. Alexius Health is a regional health network with a tertiary hospital in Bismarck, the system also consists of critical access hospitals (CAHs) in Carrington, Dickinson, Devils Lake, Garrison, Turtle Lake, Washburn and Williston and numerous clinics and outpatient services. CHI St. Alexius Health manages four CAHs in North Dakota - Elgin, Linton, and Wishek, as well as Mobridge Regional Medical Center in Mobridge, S.D. CHI St. Alexius Health offers a comprehensive line of inpatient and outpatient medical services, including: a Level II Trauma Center, primary and specialty physician clinics, home health and hospice services, durable medical equipment services, a fitness and human performance center and ancillary services throughout western and central North Dakota.
CHI St. Alexius Health is part of CommonSpirit Health, a nonprofit, Catholic health system dedicated to advancing health for all people. It was created in February 2019 through the alignment of Catholic Health Initiatives and Dignity Health. CommonSpirit Health is committed to creating healthier communities, delivering exceptional patient care, and ensuring every person has access to quality health care.
CHI St. Alexius also provides you with the quality care you provide to others. We care about our employees well-being and offer benefits that complement work/life balance.
We offer the following benefits to support you and your family:
- Care@Work program supporting any child care, pet care, or adult dependent needs
- Employee Assistance Program (EAP) for you and your family
- Health/Dental/Vision Insurance
- Flexible spending accounts
- Voluntary Protection: Group Accident, Critical Illness, and Identity Theft
- Adoption Assistance
- Paid Time Off (PTO)
- Tuition Assistance for career growth and development
- Matching Retirement Programs
- Wellness Program
Responsibilities
CHI St. Alexius is looking for a Full Time Credentialing Specialist to join the team!
The Credentialing Specialist is responsible for ensuring the credentialing program and all related credentialing, recredentialing and privileging functions are maintained in accordance with policy and health plan regulatory standards. The Credentialing Specialist ensures the organization and medical groups meet health plan and government regulatory requirements, including delegated functions pertaining to credentialing, credential file auditing, organizational provider credentialing, organizational provider auditing, primary source verification, etc. They consult and collaborate with physicians and operational leaders on credentialing related issues and potential credentialing related provider contract terminations. The Credentialing Specialist coordinates/supports credentialing committees to meet the organizations' bylaws, administrative policies, health plan contractual requirements and committee charters. They ensure interdepartmental compliance with policies that support onboarding, credentialing, recredentialing, privileging and network management functions. Evaluates a provider's qualifications, training, certification and experience to ensure he/she meets all Credentialing Eligibility Criteria and works directly with the medical group's President, Chief Medical Officer (CMO), applicable Credentialing Committee and VP of Operations/other operational leadership when an applicant fails to meet criteria or is denied credentialing. Reviews, evaluates, summarizes and presents a provider's credentialing application and supporting documentation, including the preparation of licensing actions and malpractice case summary documents for credentialing, peer review and/or quality committee review.
Qualifications
High school diploma or equivalent
Three years experience in credentialing or closely related health care administration experience.
