LOCATION: Columbia, Missouri

ABOUT THE JOB

The Credentialing Specialist II role will support all aspects of the MU Health Care credentials verification process for medical staff, advanced practice professionals, and University Physician (UP) billing staff during the initial appointment and re-credentialing process.

SALARY RANGE $22.00 - $34.74

ABOUT US

MU Health Care is a growing academic health system in mid-Missouri comprised of multiple hospitals - including the region's only Level 1 Trauma Center and region's only Children's Hospital - and over 50 specialty clinics located throughout the region.

As an MU Health Care employee, you will be part of an exceptional team committed to our mission of saving and improving lives and supporting our team members to achieve their personal and professional goals. Our core values of inclusion, respect, service, discovery, responsibility, and excellence foster a collaborative work environment where you can grow your career.

Learn more about MU Health Care. Learn more about living in Columbia, MO.

EMPLOYEE BENEFITS

Health, vision, and dental insurance coverage starting day one

Generous paid leave and paid time off, including 9 paid holidays

Multiple retirement options, including 100% match up to 8% and full vesting in three years

Tuition assistance for employees (75%) and immediate family members (50%)

Discounts on cell phone plans, rental cars, gyms, hotels, and more.

See a comprehensive list of benefits here.

ESSENTIAL FUNCTIONS

• Assemble, prepare, verify, and present the credentialing and re-credentialing application materials for all MU Health Care medical staff, advanced practice professional staff, and UP billing staff, as applicable.
• Ensure ongoing maintenance of state and federal licensure/registration.
• Enter credentialing data into electronic systems while maintaining/updating databases as needed to assure records accuracy.
• Maintain the permanent credentials files on all applicable medical staff members, advanced practice professionals, and UP billing staff.
• Maintain data integrity and appropriately correct identified data errors or inconsistencies.
• Ensure compliance with regulatory bodies such as DNV, NCQA, and CMS, and continued compliance with applicable MU Health Care medical staff bylaws and policies.
• Identify conflicting or questionable information while processing applications and highlight sensitive information for the committee(s) as appropriate.
• Maintain a state of readiness for review/audit by delegated credentialing entities, licensing, and accrediting agencies.
• Utilize Medical Staff Office and other prescribed databases to produce reports, lists, and rosters.
• Assure the confidentiality and integrity of the credentialing verification program and process.
• Provide medical staff committee support as assigned by the supervisor.
• Evaluate clinical privilege requests for criteria compliance and compare them to prior approved privileges. Track and address identified discrepancies.
• Draft correspondence and communicate directly with department coordinators, physicians, administration, or clinical chairs
• Prepare specialized reports as requested, including analysis, and presentation of findings.
• Coordinate and manage required data pulls for periodic managed care and regulatory audits. Analyze data for process consistency. Act as liaison between third-party payors to process audit requests and resolve audit discrepancies or data inconsistencies.
• Assure the confidentiality and integrity of all aspects of the credentialing verification program and process through regular review or special or routine reports to determine protocol deviations when processing applications.
• Communicate problems identified during regular audits to proactively resolve future problems or processes, and assure data integrity. Enter data into electronic systems while maintaining/updating databases as needed to assure records accuracy.
• Assist the Director of Medical Staff Affairs and GME in coordinating special projects (i.e., confidential and protected peer review activities, and/or unprofessional behavior reviews).
• May complete unit/department specific duties and expectations as outlined in department documents.

REQUIRED QUALIFICATIONS

Bachelor's degree in business, health administration, finance, or an equivalent combination of education and experience from which comparable knowledge, skills, and abilities can be acquired.

Two (2) years of experience with graduate medical education, medical staff credentialing, HR, provider enrollment, or work that involves confirming work history, education, training, background, and/or reference checks, or similar experience.

PREFERRED QUALIFICATIONS

Certified Professional Medical Services Management (CPMSM) or Certified Provider Credentialing Specialist (CPCS) certification by the National Association of Medical Staff Services (NAMSS).

Experience with the Joint Commission (TJC), Det Norske Veritas (DNV), National Council of Quality Assurance (NCQA), and Utilization Review Accreditation Commission (URAC) credentialing standards.

Additional license/certification requirements as determined by the hiring department.

Equal Opportunity Employer

The University of Missouri System is an Equal Opportunity Employer. Equal Opportunity is and shall be provided for all employees and applicants for employment on the basis of their demonstrated ability and competence without unlawful discrimination on the basis of their race, color, national origin, ancestry, religion, sex, pregnancy, sexual orientation, gender identity, gender expression, age, disability, or protected veteran status, or any other status protected by applicable state or federal law. This policy applies to all employment decisions including, but not limited to, recruiting, hiring, training, promotions, pay practices, benefits, disciplinary actions and terminations. For more information, visit https://www.umsystem.edu/ums/hr/eeo.

All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex, pregnancy, sexual orientation, gender identity, gender expression, age, disability, or protected veteran status, or any other status protected by applicable state or federal law.