At Children’s Wisconsin, we believe kids deserve the best.

Children’s Wisconsin is a nationally recognized health system dedicated solely to the health and well-being of children. We provide primary care, specialty care, urgent care, emergency care, community health services, foster and adoption services, child and family counseling, child advocacy services and family resource centers. Our reputation draws patients and families from around the country.

We offer a wide variety of rewarding career opportunities and are seeking individuals dedicated to helping us achieve our vision of the healthiest kids in the country. If you want to work for an organization that makes a difference for children and families, and encourages you to be at your best every day, please apply today.

Please follow this link for a closer look at what it’s like to work at Children’s Wisconsin: https://www.instagram.com/lifeatcw/

Job Summary

Working under the direction of the manager of Medical Staff Services, this role coordinates the operational management of the professional provider credentialing, privileging and reappointment program to ensure the program's integrity as well as support of the functions of the CHW – Milwaukee (CHW-MKE), Surgicenter of Greater Milwaukee (SGM) and CHW – Fox Valley (CHW-FV) medical staffs.

Essential Functions

• Coordinates the completion and tracking of the verification and credentialing process for CHW-MKE, SGM, CHW-FV and Payer Contracting.

• Ensures that initial appointment and reappointment files are processed within the expected timeframe, LOA and temporary privileges and resignations are handled appropriately and that all required and relevant information is included to meet any regulatory standards, Bylaws and department procedures.

• Works with medical staff leadership to assure that all follow up or inquiries on specific issues and discrepancies in provider files are completed and the appropriate documentation is in the physician's file.

• Ensures that there is ongoing monitoring and reporting of the status of board certification, licenses, DEA certificates, malpractice and other certifications that may expire.

• Manages the production of credential reports for the Credentials committees, MEC and the Board in collaboration with SGM, FV and Payer Contracting which includes integration of provider performance information and preparation of charts for review.

• Participates in continued service readiness for Joint Commission accreditation activities. Assists with continuous improvement of credentialing systems and workflow to maintain compliance with TJC and NCQA standards as applicable to the work. Serves as an organizational expert in the professional provider credentialing process. Participates in continuous improvement of department processes across all of the health system to assure that policies, processes and services are consistent, meet regulatory regulations, customer needs and are continually improving.

• In collaboration with the manager, coaches and assists with performance appraisals for the areas of responsibility. Optimizes, directs and delegates work to appropriate staff, providing education, support, resources and opportunities for professional growth.

• Works with Database Coordinator on development and annual review and revision of privilege forms for all locations and assists with Payer Contracting audits if needed.

• As directed by the manager, supports the work of the CMO, associate CMOs, elected medical staff leader and committee chairs. This may include support of medical staff committees, medical staff elections, education, onboarding, provider performance evaluations, communication and participation in planning and execution of events.

• Functions as a credentialing associate for approximately 40 hours per pay period.

Legacy Essential Functions

• Obtains specific information related to physician complaints and peer review cases and forwards to the Manager of Clinical Quality Improvement and Credentialing

• Works closely with Provider Relations and the Manager of Clinical Quality Improvement and Credentialing during the credentialing process to ensure all credentialing requirements are met, appropriate procedures are followed and that additional information is sought if necessary.

• Initiates implementation of new processes required to meet credentialing requirements or new processes for making the credentialing process more productive and efficient.

• Maintains working knowledge of NCQA and State of Wisconsin credentialing standards, rules and regulations.

• Understands the importance of and is responsible for maintaining accurate practitioner information into the CCHP credentialing database.

• Maintains a log or system to track and communicate progress of credentialing process.

• Supports the Credentialing Committee with meeting preparation, the compilation of credentialing monthly minutes and coordination of follow up items.

• Prepares all correspondence for both medical staff and allied health professionals.

• Completes reports to the National Practitioner Database (NPDB) and any other entity required by NCQA ,the State of Wisconsin and/or the Federal Government

• Perform any administrative duties required to maintain the account for the National Practitioner Database (NPDB)

• Updates/maintains the Credentialing Policies and Procedures to keep in compliance with NCQA’s Standards and updates according to CCHP’s credentialing processes

• Works with the CCHP NCQA Project Manager to support mock audits, draft policy changes, and ensure compliance with timelines for NCQA audit

Education:

• High School graduate or Certificate of General Educational Development (GED) or High School Equivalency Diploma (HSED) NAMSS Certification as a Medical Staff Coordinator or Certified Provider Credentialing Specialist accepted in lieu of degree required

• Associate's Degree preferred

Experience:

• 2+ years medical staff office or hospital based quality or administrative experience required

Knowledge, Skills and Abilities:

• Strong interpersonal skills, organizational and planning abilities, quality improvement expertise and customer orientation in order to interact effectively with physicians and hospital administrative staff.

• Must be able to deal effectively with complex medical staff issues.

• Proficient in Microsoft Word, PowerPoint and Excel.

• Ability to act independently and complete projects from beginning to end with minimal supervision.

• Excellent organization skills and the ability to manage multiple projects.

• Comfort with data retrieval methodology and analytical ability/skills to analyze trends and to proactively problem-solve.

• Strong written and verbal communication skills. Skillful in development and presentation of materials to a group.

Licenses and Certifications:

• CPCS-Certified Provider Credentialing Specialist - Certification Commission of National Association Medical Staff Services Preferred

• CPCS-Certified Provider Credentialing Specialist - Certification Commission of National Association Medical Staff Services preferred

Required for All Jobs:

• This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that may be requested in the performance of this job.

• Employment is at-will. This document does not create an employment contract, implied or otherwise.

• Fully Remote Position

Children's Wisconsin is an equal opportunity / affirmative action employer. We are committed to creating a diverse and inclusive environment for all employees. We treat everyone with dignity, respect, and fairness. We do not discriminate against any person on the basis of race, color, religion, sex, gender, gender identity and/or expression, sexual orientation, national origin, age, disability, veteran status, or any other status or condition protected by the law.

Certifications/Licenses: