Credentials Verification Spec, Full Time, Days

At Northwestern Medicine, every patient interaction makes a difference in cultivating a positive workplace. This patient-first approach is what sets us apart as a leader in the healthcare industry. As an integral part of our team, you'll have the opportunity to join our quest for better healthcare, no matter where you work within the Northwestern Medicine system. At Northwestern Medicine, we pride ourselves on providing competitive benefits: from tuition reimbursement and loan forgiveness to 401(k) matching and lifecycle benefits, we take care of our employees. Ready to join our quest for better?

The  Credentials Verification Specialist  II reflects the mission, vision, and values of NM, 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 is responsible for a variety of tasks impacting onboarding of new providers, ongoing compliance with regulatory and accreditation bodies including JC, IDPH, CMS and NCQA, and database management/reporting. 

Responsibilities:

• Support various processes within the organization, ensuring accuracy, efficiency, and adherence to established standards.
• Utilize critical thinking skills to analyze and evaluate process workflows, identifying areas for improvement and implementing solutions.
• Manage the integrity of data by accurately recording and documenting information, ensuring data quality and consistency.
• Collaborate with team members to execute tasks according to standard work procedures, ensuring consistency and efficiency.
• Continuously seek opportunities for personal and professional growth, staying updated on industry trends and best practices.
• Work as a good team member, actively participating in team meetings, sharing ideas, and contributing to a positive work environment.
• Communicate effectively with team members and stakeholders, providing updates, addressing inquiries, and resolving issues promptly.
• Maintain confidentiality and handle sensitive information securely, adhering to data protection policies and regulations.
• Support the implementation of process improvements, assisting with testing, documentation, and training as required.
• Provide exceptional customer service, both internally and externally, ensuring a positive experience for all stakeholders.
  
  Additional Functions         
   
• Serve as critical resource for new providers including management of on-boarding milestones and milestone compliance.
• Manage provider-specific data elements to ensure downstream internal and external systems receive, act upon and display accurate information.
• Provide data management support as assigned.
• Special projects as requested

Required:

• Associate’s Degree plus 2 years of consecutive work experience in medical staff services or credentials verification; healthcare administration; payor/managed care enrollment or other experience with transferrable skills OR Bachelor’s Degree plus demonstrated transferrable skills.
• Proven experience in a similar role, demonstrating strong critical thinking and problem-solving skills.
• Proficient computer skills, including experience with data entry, database management, and Microsoft Office Suite.
• Demonstrated abilities in data management, analysis, synthesis, and reporting.
• Excellent attention to detail and organizational skills, ensuring accuracy and completeness in all tasks performed.
• Ability to work effectively as part of a team, collaborating with colleagues to achieve common goals.
• Strong written and verbal communication skills, with the ability to convey information clearly and professionally.
• Demonstrated commitment to maintaining confidentiality and handling sensitive peer review-related information securely.
• Willingness to learn and grow, adapting to changing priorities and acquiring new skills as needed.
• Strong work ethic and a proactive approach to problem-solving.
• Familiarity with process improvement methodologies.

Preferred:

• Bachelors Degree and 3-5 years credentialing experience

Interacts with:

• Employed and independent physicians and other professionals and their practice administration
• NM Medical Staff Office, Provider Operations, and NMPN teams
• Regulatory and licensing agencies and other official providers of credentials information
• Official providers and agencies of credentials information

Northwestern Medicine is an affirmative action/equal opportunity employer and does not discriminate in hiring or employment on the basis of age, sex, race, color, religion, national origin, gender identity, veteran status, disability, sexual orientation or any other protected status.