Overview Responsible for the coordination of the provider credentialing activities within the Department of Patient Accounts, to include being the organizational resource for government/third party payer credentialing regulations, and in maintaining systems which are consistent with current industry standards. As appropriate, responsible for the application process for provider numbers for Durable Medical Equipment (DME) and for obtaining the appropriate laboratory numbers by physician for Illinois Department of Public Aid. Performs other duties as assigned. Responsibilities Essential Duties and Responsibilities Understands and maintains an in depth knowledge regarding the requirements for credentialing physicians with Wisconsin and Illinois Medicare, Medicaid, Blue Cross and other third payers as necessary. Responsible for implementing and obtaining NPI numbers per provider. Works closely with the Medical Staff Office, Clinic Directors, Clinic Finance, Information Systems and physician recruiters to obtain necessary information on new physicians to complete the credentialing process, in a timely manner, necessary to get claims paid. Understands the idiosyncrasies of the government forms, which forms are used and what information is necessary for credentialing physicians, physical therapists, CRNAs (Nurse Anesthetists), Physician Assistants, and residents. Responsible for investigation or follow-up of claims work que. Understands facility enrollment as appropriate. Utilizes a system, such as CACTUS, to house and maintain all credentialing information, to include, but not be limited to: when applications are submitted, when payer numbers were received, and what numbers have been assigned to each individual, by location and payer. Ensures confidentiality and accuracy of all credentialing information. Utilizes the information in Cactus to ensure the re-credentialing process begins prior to any expiration of current statuses/numbers. Obtains and maintains information necessary for credentialing Illinois physicians with each Mercy laboratory in Illinois with the Illinois Department of Public Aid. Processes information on a timely basis and monitors expiration dates. As appropriate, is knowledgeable and completes forms/documents as necessary for obtaining provider numbers for Durable Medical Equipment (DME) by location. Monitors expiration dates and initiates the re-certification process in a timely manner. Responsible for ensuring that all the data maintained in Cactus is current and that all personal information is kept confidential. Responsible for communicating payer numbers received to a Patient Accounts Application Analyst to ensure the McKesson Plus system is current with the information necessary for timely billing of claims. Provides reports as necessary for the Credentialing Committee, Patient Accounts, clinics, etc. Facilitates communication within Mercy Health System on the credentialing process by being an active participant on the Credentialing Committee. Develops, maintains, and implements policies and procedures necessary to support the credentialing process. Responsible for educating partners in the application of the credentialing policies and procedures Culture of Excellence Behavior Expectations To perform the job successfully, an individual should demonstrate the following behavior expectations: Quality - Follows policies and procedures; adapts to and manages changes in the environment; Demonstrates accuracy and thoroughness giving attention to details; Looks for ways to improve and promote quality; Applies feedback to improve performance; Manages time and prioritizes effectively to achieve organizational goals. Service - Responds promptly to requests for service and assistance; Follows the Mercyhealth Critical Moments of service; Meets commitments; Abides by MH confidentiality and security agreement; Shows respect and sensitivity for cultural differences; and effectively communicates information to partners; Thinks system wide regarding processes and functions. Partnering - Shows commitment to the Mission of Mercyhealth and Culture of Excellence through all words and actions; Exhibits objectivity and openness to other's views; Demonstrates a high level of participation and engagement in day-to-day work; Gives and welcomes feedback; Generates suggestions for improving work: Embraces teamwork, supports and encourages positive change while giving value to individuals. Cost - Conserves organization resources; Understands fiscal responsibility; Works within approved budget; Develops and implements cost saving measures; contributes to profits and revenue. Education and Experience Associates degree AND 1 year of experience in a healthcare-related environment, preferably in credentialing/provider enrollment; OR minimum 3 years of experience in a healthcare-related environment required, preferably in credentialing/enrollment. Certification and Licensure Associate's degree and 1 year of healthcare credentialing/enrollment experience preferred (healthcare facility, managed care setting, CVO, medical staff office, or enrollment), or a minimum of 5 years of experience in credentialing (preferred), or a minimum of 5 years of experience in a healthcare business support area required. Three years' experience working with Wisconsin and Illinois Medicare and Medicaid credentialing regulations, plus managed care payers preferred. Skills and Abilities Mathematical Skills Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs. Computer Skills To perform this job successfully, an individual should have knowledge of Patient Accounting software; Spreadsheet software and Word Processing software. CACTUS experience a plus. Language Skills Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization. Reasoning Ability Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations. Special Physical Demands The Special Physical Demands are considered Essential Job Functions of the position with or without reasonable accommodations. While performing the duties of this Job, the employee is regularly required to use hands to finger, handle, or feel. The employee is frequently required to sit; reach with hands and arms and talk or hear. The employee is occasionally required to stand; walk and stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision and ability to adjust focus. Level of Supervision N/A Supervises May supervise as designated by Director. Benefits Mercyhealth offers a generous total rewards package to eligible employees including, but not limited to: · Comprehensive Benefits Package: Mercyhealth offers a retirement plan with competitive matching contribution, comprehensive medical, dental, and vision insurance options, life and disability coverage, access to flexible spending plans, and a variety of other discounted voluntary benefit options. · Competitive Compensation: Mercyhealth offers market competitive rates of pay and participates in various shift differential and special pay incentive programs. · Paid Time Off: Mercyhealth offers a generous paid time off plan, which increases with milestone anniversaries, to allow employees the opportunity for a great work-life balance. · Career Advancement: Mercyhealth offers a number of educational assistance programs and career ladders to support employees in their educational journey and advancement within Mercyhealth. · Employee Wellbeing: Mercyhealth has a focus on wellbeing for employees across the organization and offers a number of tools and resources, such as an employer-sponsored health risk assessment and a Wellbeing mobile application, to assist employees on their wellbeing journey. · Additional Benefits: Mercyhealth employees have access to our internal and external employee assistance programs, employee-only discount packages, paid parental and caregiver leaves, on-demand pay, special payment programs for patient services, and financial education to help with retirement planning.