Credentialing Quality Reviewer

Building Location:

Support Services Center - Fargo

Department:

1005400 MEDICAL STAFF OFFICE - EH SS

Job Description:

Develop, document, implement, review, and maintain credentialing process and training guides. Implement a departmental review process of credentialing files to ensure compliance with Joint Commission (JC) and National Committee for Quality Assurance (NCQA) standards. Conducts audits and quality assurance activities related to credentialing. Problem solves and identifies areas for improvement and additional training opportunities within the credentialing process. Provides ongoing training to employees. Ensures accurate record keeping in the credentialing database. Involved in department performance improvement. Responsible for privilege form criteria maintenance and system review of these forms on a regular basis. Completes special projects as assigned and serves as a project coordinator for department initiatives.

Education Qualifications:

Educational Requirements:

• Associates degree or equivalent experience

Key Responsibilities:

• Quality Review of Credentialing files for National Committee for Quality Assurance (NCQA) and Joint Commission (JC) compliance
• Conducts audits and quality assurance activities related to credentialing
• Training of new team members, creates and updates training materials, provides department training as needed
• Develops and maintains system-wide clinical privilege forms
• Conducts research related to industry standards for privilege criteria and partners with practitioner SMEs to establish appropriate criteria
• Provides overview of proposed privilege form revisions to the Credentials Committees and Medical Staff Executive Committees
• Project coordination for the Medical Staff Services Department
• Identifies opportunities and areas for improvement within the credentialing process, partners with management to address
• Ensures accurate data entry into the credentialing database
• Tracks quality measures to identify trends with team members
• Other duties as assigned 

Required Qualifications:

• 3 years credentialing or equivalent experience

Preferred Qualifications:

• NAMSS (National Association of Medical Staff Services) certification; either CPCS (Certified Provider Credentialing Specialist) or CPMSM (Certified Professional in Medical Services Management)
• Working knowledge of medical staff/provider credentialing concepts and comprehensive knowledge of state, federal regulatory requirements and accreditation standards relating to the organized medical staff
• Training and quality assurance experience
• Knowledge of best practices in the development of criteria-based clinical privilege forms

Licensure/Certification Qualifications:

FTE:

1

Possible Remote/Hybrid Option:

Remote

Shift Rotation:

Day Rotation (United States of America)

Shift Start Time:

Shift End Time:

Weekends:

Holidays:

No

Call Obligation:

No

Union:

Union Posting Deadline:

Compensation Range:

$22.81 - $34.22

Employee Benefits at Essentia Health:

At Essentia Health, we’re committed to supporting your well-being, growth, and work-life balance. Our comprehensive benefits include medical, dental, vision, life, and disability insurance, along with supplemental options to fit your needs. We offer a 401(k) plan with employer contributions to help you plan for the future, and we invest in your professional development through training, tuition reimbursement, and educational programs. To help you thrive both at work and at home, we provide flexible scheduling, generous time off, and wellness resources focused on your physical, mental, and emotional health. Please note that benefit eligibility may vary. For full details, refer to your benefit summary or contact our HR Service Center at (218) 576-0000.