Privileging and Credentialing Operations Specialist

Job not on LinkedIn

🔥 28 minutes ago

🇺🇸 United States – Remote

💵 $60k - $78k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚙️ Operations

👻 Ghost score 0%

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Monogram Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2019

💼 Consulting

🛡️ Insurance

📦 Logistics

Consulting • Insurance • Logistics

Monogram Health is a leading multispecialty provider that delivers in-home, evidence-based care and benefit management for patients with complex, multiple chronic conditions, with a strong focus on chronic kidney disease and related metabolic, cardiovascular, pulmonary, and behavioral health needs. The company coordinates multispecialty clinical teams (nephrology, cardiology, endocrinology, pulmonology, behavioral health, and palliative care), provides 24/7 home-based support including home dialysis and medication management, and partners with payers and physician groups to improve outcomes, reduce hospitalizations, and lower costs.

📋 Description

• Prepare and submit medical staff and privileging applications, including EMR access, initial appointments, and reappointments • Tailor applications to facility affiliation levels, privileging requirements, and standards • Work with clinicians to obtain required information and documentation • Serve as the primary contact between Monogram Health and hospital credentialing offices • Track applications through completion, expedite approvals, and communicate status, outstanding items, and roadblocks • Report status and projected timelines to executive leadership and escalate roadblocks • Complete ad hoc privileging research for strategic initiatives • Coordinate workflows across Licensing, Provider Enrollment, Primary Source Verification, and Privileging • Manage intake and workload trackers, practitioner rosters, and offboarding trackers • Support onboarding and offboarding documentation, including DocuSign packets • Maintain credentialing records, notes, status updates, and supplemental documents • Pull system reports and manage daily workflow priorities • Prepare weekly leadership reports and twice-monthly ProviderTrust Credentialing reports • Conduct data integrity audits and monthly Ongoing Monitoring • Participate in cross-functional efficiency and compliance projects • Provide backup support for payer enrollment and internal credentialing • Support additional credentialing, provider operations, and strategic initiatives as needed

🎯 Requirements

• High school diploma or GED required • Bachelor's degree or equivalent experience preferred • Certification as a Certified Provider Credentialing Specialist (CPCS) or Certified Professional in Medical Services Management (CPMSM) is a plus • Minimum of three (3) years of progressively responsible experience in medical staff services, provider credentialing, hospital privileging, healthcare operations, or healthcare compliance • Direct responsibility for hospital medical staff applications and provider affiliations • Demonstrated understanding of hospital credentialing, affiliation levels, and privileging standards, including NCQA and Joint Commission credentialing requirements • Proficiency in Microsoft Office, particularly Excel and Word • Proficiency in Adobe Acrobat, DocuSign, and Smartsheet • Familiarity with credentialing software • Ability to independently manage multiple time-sensitive application processes • Demonstrated research and analytical skills • Effective communication and relationship-building skills with hospital credentialing departments, providers, leadership, external agencies, and internal stakeholders • Adaptability and comfort with change • Proven organizational skills and attention to detail • Ability to interpret regulations and handle confidential information with discretion • Professionalism, poise, and strong critical thinking, judgment, and decision-making skills

🏖️ Benefits

• Medical, dental, and vision insurance • Employee assistance program • Employer-paid and voluntary life insurance • Disability insurance • Health and flexible spending accounts • 401k with employer match • Financial wellness resources • 20 PTO days • 7 paid holidays • 1 floating day • Paid parental leave • Work life assistance resources • Physical wellness perks • Mental health support • Employee referral program • BenefitHub employee discounts

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