Credentialing Coordinator Sr

Ann & Robert H. Lurie Children’s Hospital of Chicago provides superior pediatric care in a setting that offers the latest benefits and innovations in medical technology, research and family-friendly design. As the largest pediatric provider in the region with a 140-year legacy of excellence, kids and their families are at the center of all we do. Lurie Children’s is ranked in all 10 specialties by U.S. News & World Report.

About the role

Provides support to the FPP Managed Care Administrator of Management Services and Director of Credentialing through primary source verification of information provided on the provider’s application. Responsible for maintaining a credentialing process in accordance with NCQA and other State and Federal Regulatory Agencies. Processes and updates physician applications and sends completed applications to managed care contracted entities. Helps ensure compliance with NCQA, licensing, and accrediting agency requirements.

Responsibilities

• Manages credentialing and re-credentialing processes according to NCQA Standards, State and Federal guidelines, FPP Policies and Procedures, and FPP Bylaws.
• Coordinates materials for FPP Credentialing Committee; assists Director of Credentialing with FPP Credentialing and Recredentialing Policies and Procedures.
• Follows through with Credentialing Committee approvals; adheres to State recredentialing cycles.
• Responsible for credentialing and recredentialing for FPP clients and the process for new and existing FPP physicians.
• Develops billing invoices and calculates receivables for FPP clients.
• Responsible for FPP site visits, medical record reviews, and querying the National Practitioner Data Bank.
• Inputs data into FPP Credentialing database software and provides monthly querying of federal and state Medicare sanction databases.
• Maintains physician portfolios and files; sends physician demographics, adds, terminations, and changes to managed care payors electronically or by paper copy.
• Resolves issues regarding credentialing from payors, Lurie Children’s staff, and families via phone, fax, or letter; follows up with payors on any issues and reconciliations of payor rosters to ensure accuracy.
• Reviews current regulatory standards to ensure compliance.
• Develops a credentialing training program for Office Coordinators; trains Office Coordinators, Academic Office Coordinators, Point of Service, and Managers regarding managed care credentialing.
• Coordinates malpractice verification with Risk Management; hospital verifications and credentialing eligibility with Practice Plan Administrators and Medical Staff Office.

Requirements

• BA preferred or minimum two years experience in credentialing and recredentialing process.
• Must be eligible for certification by the National Association of Medical Staff Services as a Credentialing Specialist (CPCS).
• Must have experience with an NCQA audit.
• Data processing proficiency in Microsoft Excel and Access 97 or higher.
• Ability to work under pressure, be detail-oriented, and have excellent cognitive and communication skills.

Pay

$21.00–$32.55 hourly. At Lurie Children’s, we are committed to competitive and fair compensation aligned with market rates and internal equity, reflecting individual contributions, experience, and expertise.

Benefits

For full-time and part-time employees who work 20 or more hours per week, we offer a generous benefits package that includes:

• Medical, dental, and vision insurance.
• Employer-paid group term life and disability.
• Employer contribution toward Health Savings Account.
• Flexible Spending Accounts.
• Paid Time Off (PTO), paid holidays, and paid parental leave.
• 403(b) with a 5% employer match.
• Various voluntary benefits including supplemental life, AD&D, disability, critical illness, accident, and hospital indemnity coverage.
• Tuition assistance and student loan servicing and support.
• Adoption benefits.
• Backup childcare and eldercare.
• Employee Assistance Program and other specialized behavioral health services and resources for employees and family members.
• Discount on services at Lurie Children’s facilities.
• Discount purchasing program.