Full-Time Credentials Verification Spec

The Credentialing Verification Specialist reflects NM's mission, vision, and values, adheres to the organization's Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.

The Credentials Specialist examines credentials and processes applications for physicians and other health care practitioners applying to NM for appointment, clinical privileges, and/or reappraisal/renewal, ensuring compliance with all standards.

Responsibilities:

• Initiate, verify, examine, and maintain the confidential credentials process for all professional applicants.
• Ensure compliance with regulatory and NM criteria for practicing in Illinois (or other states). Verify current documentation (licenses, malpractice insurance, board certification, etc.).
• Examine applications for completeness and required documentation, identifying missing data, timelines, and gaps.
• Conduct follow-up with applicants on adverse elements.
• Investigate issues through to resolution, verifying all credentials data.
• Examine and evaluate credentials information, cross-referencing and comparing to applications and CVs. Identify acceptable or adverse information and compliance with NM medical staff qualifications.
• Investigate discrepancies and misstatements through to resolution.
• Report adverse information and unresolved questions to leads or Director.
• Determine completion of the investigation and credentials process.
• Flag time-sensitive items for reverification.
• Generate profiles and reports.
• Maintain accurate and current credentials databases.
• Monitor and track application status.
• Ensure accessibility of applicant records.
• Maintain tracking documentation.
• Provide first contact and customer service to applicants and credentialing staff.
• Communicate regularly about application status.
• Perform essential functions in compliance with accreditation, federal and state laws.
• Maintain knowledge base applicable to credentialing.

Required:

• Associate's degree plus 2 years consecutive experience in medical staff services or credentials verification; healthcare administration; or payor/managed care enrollment, OR 4 years consecutive work experience in lieu of degree.

Strong knowledge of Microsoft Office products, excellent interpersonal, customer service and communication skills.

Preferred: Bachelor's degree and 3-5 years credentialing experience.

Northwestern Medicine is an affirmative action/equal opportunity employer.

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