Credentialing Specialist

The Credentialing Assistant is responsible for assisting the Credentialing Specialist and coordinating the centralized credentialing and privileging program, including activities that ensure that Swope Health Services has a provider network of the highest quality. This position develops and implements processes, procedures, and policies in accordance with standards established by HRSA, Joint Commission and other grant makers as applicable. This position is also responsible for the timely enrollment of practitioners in commercial insurance plans as eligibility rules and standards dictate. Additional responsibilities include the design and successful delivery of HR transactional processes, as well as leading the progression of the function and the broadening of the scope of services provided.

Successful Candidate will have: 

• Lead groups of a therapeutic or psycho-educational nature as part of treatment services.
• Develops and implements centralized credentialing and privileging processes and procedures for Swope practitioners and maintains confidential credentialing files.
• Prepares credentialing and privileging documents for all initial appointments and reappointments in a timely and complete manner for presentation to the Board of Directors. 

• Works closely with physicians, mid-levels, licensed independent practitioners and other licensed or certified practitioners and professional staff to acquire necessary materials and information for enrollment with commercial insurance plans. 

• Ensures compliance with HRSA, JCAHO and other grant makers or certification standards for credentialing and privileging of various practitioner types.
• Maintains and/or acquires delegated credentialing as appropriate to benefit Swope Health. 
• Uses credentialing software proficiently and adds credentialing information to the HR associate record as necessary. 
• Coordinates with various departments to ensure communication of completed credentialing and privileging requirements to ensure appropriate billing for services. 
• Convenes monthly Credentialing Committee meetings, prepares agenda, and records, and ensures the decisions of the committee are acted upon. Attends Board meetings as required. 
• Coordinate with the HR Talent Acquisition team on new hire credentialing and provider enrollment. 
• Ensure team members follow best practices and maintain service level agreements. 
• Monitors/resolve team issues and associate concerns 
• Suggest or innovate on processes as deemed appropriate.

• Exercises confidentiality regarding all information, results, data and other sensitive material. 

• Other duties as assigned. 

Education/Qualifications 

• Associate degree in business administration or equivalent experience, bachelor’s degree preferred. 
• 1-5 years credentialing experience or relevant work experience required. Certified Provider Credentialing Specialist certification preferred. 

About Swope Health Services:

Each year, Swope Health serves over 45,000 patients, encompassing more than 200,000 visits in four counties on both sides of the state line. Our team members are proud of the work we do and the promise we've made – delivering coordinated care that values the needs of the whole person and championing better health in our community.

Swope Health is a special place that cares for the people who need it most, wherever they are in the community. As part of our promise to battle health inequities and provide high-quality, comprehensive care, we make care visible. That means we proudly deliver our promise through every action, every day.

Swope Health Services supports its team members with:

• Medical benefits (including a Health Savings Account option), dental and vision
• 401(k) retirement plan with company match
• Company-paid benefits such as life insurance, Accidental Death & Dismemberment, and Short- and Long-Term Disability
• Flexible Spending Account
• Paid Days Off beginning at 12 days annually, effective the first day of employment
• Eight annual company-paid holidays; One annual paid personal day

Swope Health is an affirmative-action, equal-opportunity employer. We consider all qualified applicants without regard to race, color, creed, religion, gender, national origin, age, marital status, veteran status or disability.