Toledo Region Jobs
Leverage our employer network to build your career in the Toledo Region.
Mercy Health
Location: St. Anne Hospital
Shift: Days/Full-time
SUMMARY:
The Credentialing Auditor will provide operational oversight for the quality and audit function of all Centralized Verification Office (CVO) credentialing and credentialing files to ensure the accuracy and completeness of verifications done by the CVO. The Credentialing Auditor will be responsible for credentialing and re-credentialing regional providers for hospital privileges and preparing files before review by Medical Staff Leaders and sending to the regional Medical Staff Offices. The Credentialing Auditor will work in collaboration with the Regions Medical Staff Office Professionals to provide support for those functions that impact the multiple facilities within the region.
ESSENTIAL FUNCTIONS:
Audits 100% of credentialing and re-credentialing files submitted by the Credentialing Specialists for accuracy and completeness. Obtains additional information as necessary to complete the file on behalf of all Mercy North region hospitals.
Returns audited files for corrections to the relevant Credentialing Specialist for the purposes of data correction and education.
Prepares credentialing and re-credentialing files for electronic file review with the Medical Staff Leaders and meets one-on-one with Metro Leaders, if requested.
Prepares Credentialing Report for the Regional Medical Staff Offices to include on their Committee Meeting Agendas and is available to participate in the Credentials Committee meetings, if requested.
Develop, implement, and maintain Credentialing audit tools annually to ensure compliance with current Joint Commission, State, and Federal Requirements.
Works closely with Regional Director to meet the educational needs of the Credentialing/Medical Staff Specialists and provides in-service/orientation/education as needed.
Assist with all regulatory, state and federal surveys as requested.
EDUCATION:
Required: 2/year Associate degree or equivalent combination of related education.
*Combination of post-secondary education and experience will be considered in lieu of degree.
Required: Certification by the National Association Medical Staff Services as either a CPCS or CPMSM or become certified within 3 years of employment.
Minimum Years and Type of Experience: A minimum of at least 5 years’ experience in a central verification office, hospital or managed care setting.
Other Knowledge, Skills and Abilities Required: Knowledge of the acute care/hospital credentialing process including initial appointment, privilege, delineation and reappointment; Knowledge and experience in medical/legal issues and laws, and regulatory requirements (TCJ, CMS); Strong computer skills including knowledge of Cactus Software credentialing system; Strong organizational skills with required attention to detail; Ability to solve problems and resolve conflicts; excellent oral and written communication skills; Excellent interpersonal skills and ability to work effectively and efficiently with others; Ability to work independently; Ability to maintain confidential information and exhibit a professional appearance and demeanor; ability to travel.
Preferred: Proficiency with offices software applications (Microsoft Office Suite) ; presentation skills and strong time management skills.
As a Mercy Health associate, you're part of a Mission that matters. We support your well-being—personally and professionally. Our benefits are built to grow with you and meet your unique needs, every step of the way.
What we offer
Benefits may vary based on the market and employment status.
All applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability. If you'd like to view a copy of the affirmative action plan or policy statement for Mercy Health – Youngstown, Ohio or Bon Secours – Franklin, Virginia; Petersburg, Virginia; and Emporia, Virginia, which are Affirmative Action and Equal Opportunity Employers, please email recruitment@mercy.com. If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team at recruitment@mercy.com