Credentialing Assistant

Overview

Summary:

Credentialing Assistants perform a variety of duties that contribute to background verification and file preparation for the MCW credentialing function, and enrollment and maintenance of enrollment status of individual providers and clinical practice sites for public payer programs. The tasks require a consistently high degree of accuracy over a large volume of providers, and the work, though closely supervised, is relied upon and used directly in decisions regarding credentialing and enrollment.

• Prepares re-credentialing files for review and decision by MCW Credentialing Committees.
• Verifies specified information from identified primary sources, reviews re-credentialing applications for completeness, and pursues missing forms or information as needed.
• Prepares Individual Status Reports using information obtained from primary source verifications, including assembling all re-credentialing information regarding each provider into re-credentialing files for review by MCW Credentialing Committees.
• Enrolls all newly hired MCW providers into Medicare and appropriate Medicaid programs by receiving applications for participation in Medicare and Medicaid programs from new providers. Checks for completeness and pursues additional information or materials as necessary.
• Works with personnel from government payers to secure application materials as necessary. Transmits completed applications to government payer; receives and files verification of enrollment.
• Prepares Candidate Background Assessment Program (CBAP) files for review and use in hiring decisions for clinical departments.
• Receives CBAP applications from candidates for faculty physician, dentist, and psychologist positions and verifies specific information from primary sources.
• Reports results of CBAP background searches to Office of General Counsel and clinical departments.
• Maintains records noting progress of each candidate in the CBAP process in spreadsheet software.
• Maintains individual files for all candidates using the CBAP process.
• Performs Quality Assurance Audits on all completed files for accuracy prior to releasing the files to the various entities.

Knowledge of quality control, customer service standards, information management, procedural process, and recordkeeping. Computer, technical, interpersonal, oral communication, listening, and patience skills.

Minimum Required Education: High school diploma
Minimum Required Experience: 2 years
Preferred Experience: 2 years experience enrolling and maintaining credentialing status for providers.

Experience with MSOW or similar software, such as Cactus or MD-Staff.
Appropriate experience may be substituted on equivalent basis.

Work requires occasionally lifting moderate weight materials, standing, or walking continuously.

Occasional exposure to dust, noise, temperature changes, or contact with water or other liquids. Work is performed in an environmentally controlled environment.

Ability to detect and translate speech or other communication required. May occasionally require the ability to distinguish colors and perceive relative distances between objects.

• Outstanding Healthcare Coverage, including but not limited to Health, Vision, and Dental. Along with Flexible Spending options
• 403B Retirement Package
• Competitive Vacation and Paid Holidays offered
• Tuition Reimbursement
• Paid Parental Leave
• Employee & Family Assistance Program (EFAP)
• Pet Insurance
• On campus Fitness Facility, offering onsite classes
• Additional discounted rates on items such as:
  Select cell phone plans, local fitness facilities, Milwaukee recreation and entertainment etc.

For a brief overview of our benefits see:
Benefits Overview
For a full list of positions see: MCW Careers

At MCW all of our endeavors, from our internal operations to our interactions with our partners, are driven by our shared organizational values:
Caring – Collaborative – Curiosity – Inclusive – Integrity – Respect. We are committed to fostering an inclusive environment that values diversity in backgrounds, experiences, and perspectives…