Credentialing Coordinator - Medical Staff Services

45208 Cincinnati, Ohio TriHealth

Posted 3 days ago

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Job Description

Job Description

Job Overview:

The Credentialing Coordinator plays a vital role in ensuring the accuracy and compliance of medical staff credentials. This position is responsible for managing applications, verifying credentials, and maintaining strict confidentiality of physician data. The role requires attention to detail, strong organizational skills, and the ability to support credentialing committees efficiently.

Location: 4750 Wesley Ave. Norwood, OH 45212

Work hours:
  • Full-time, 80 hours bi-weekly
  • Day shift
  • This is an on-site position based in Norwood, OH, collaborating directly with the Medical Staff Services team to ensure a seamless process. Remote work is not available for this role.
Job Requirements:
  • High School Diploma or GED (Required)
  • 1-2 years of experience in healthcare (Required)
  • 1-2 years of administrative support experience (Required)
  • Strong organizational skills and attention to detail
  • Proficiency in data management and verification processes
Key Responsibilities:
  • Process initial medical staff applications, reviewing, verifying, and following up on required documentation.
  • Prepare and manage reappointment applications, ensuring compliance with credentialing standards.
  • Analyze applicant information to determine eligibility and compile provider-specific data for review.
  • Investigate and resolve discrepancies or potentially adverse findings from applications and primary sources.
  • Verify expirable documents using appropriate Primary or Equivalent Source Verification methods.
  • Maintain accurate records within the credentialing database, ensuring up-to-date provider information.
  • Assist with the administrative support of the Credentials Committee and its leadership.
  • Ensure strict confidentiality and compliance with relevant credentialing standards and regulations.
Working Conditions:
  • Primarily office-based with occasional standing and walking
  • Frequent use of computers and credentialing databases
  • Requires concentration, reasoning, and interpersonal communication

TriHealth SERVE Standards and ALWAYS Behaviors
At TriHealth, we believe there is no responsibility more important than to SERVE our patients, our communities, and our fellow team members. To achieve our vision and mission, ALL TriHealth team members are expected to demonstrate and live the following:

Serve: ALWAYS.
•Welcome everyone by making eye contact, greeting with a smile, and saying "hello"
•Acknowledge when patients/guests are lost and escort them to their destination or find someone who can assist
•Refrain from using cell phones for personal reasons in public spaces or patient care areas
Excel: ALWAYS.
•Recognize and take personal responsibility to address and recover from service breakdowns when a customer's expectations have not been met
•Offer patients and guests priority when waiting (lines, elevators)
•Work on improving quality, safety, and service
Respect: ALWAYS.
•Respect cultural and spiritual differences and honor individual preferences.
•Respect everyone's opinion and contribution, regardless of title/role.
•Speak positively about my team members and other departments in front of patients and guests.
Value: ALWAYS.
•Value the time of others by striving to be on time, prepared and actively participating.
•Pick up trash, ensuring the physical environment is clean and safe.
•Be a good steward of our resources, using supplies and equipment efficiently and effectively, and will look for ways to avoid waste.
Engage: ALWAYS.
•Acknowledge wins and frequently thank team members and others for contributions.
•Show courtesy and compassion with customers, team members and the community

Job keyword:

Healthcare Credentialing, Credentialing Specialist, Medical Staff Credentialing, Provider Enrollment, Compliance & Licensing, National Committee for Quality Assurance (NCQA), HIPAA Compliance, Healthcare Regulations, CAQH Enrollment, Credential Verification, Provider Onboarding, License & Certification Management, Contract Administration, Data Entry & Documentation, CPCS
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National Medical Director for Surgical Services

45217 Cincinnati, Ohio Elevance Health

Posted 5 days ago

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Job Description

**National Medical Director for Surgical Services**
Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
Responsible for serving as a **National Medical Director** of the general surgery solution, leading the strategic implementation of improving the health of the people we serve, influencing product strategy and design and medical management approaches that impact health care quality, cost, and outcomes, and improving access to and usefulness of health improvement tools offered to Elevance members and external clients.
**How you will make an impact:**
+ Monitors competitor products and internal medical management capabilities and responds with recommendations for improvement in company models.
+ Contributes to development of Medical Management and Quality Management strategies. Responsible for consistent adoption and implementation of all medical policies.
+ Provides clinical leadership for Utilization Management, Case Management, Disease Management, and Quality Management of National Accounts in cooperation with Regional Health Care Management (HCM) team and Chief Medical Officer.
+ Provides clinical expertise in sales planning and participates in the acquisition and retention of National Accounts.
+ Collaborates with HCM leaders to refine and improve provider and medical management services to meet the needs of National Accounts.
+ Assures the clinical relevance of account reporting regarding use of medical services by National Accounts members.
+ Communicates medical management trends and recommends company medical management responses to National Accounts.
+ Contributes to efforts to establish effective physician and hospital quality and cost profiling and education.
+ Contributes to improved provider relationships and national associations and societies (i.e., AMA, Coalition of Specialty Societies).
+ Represents company at nationally recognized speaking engagements to promote health programs.
**Minimum Requirements:**
+ Requires MD or DO and minimum of 12 years of healthcare experience; or any combination of education and experience, which would provide an equivalent background.
+ Requires current unrestricted medical licensure in applicable state(s).
+ Board certification required if applicable to the duties being performed.
+ Requires experience with population or segment health management and the education and coaching of members on wellness, prevention, and healthy lifestyles.
**Preferred Qualifications:**
+ Board certification in general surgery or a surgical subspecialty is **strongly preferred.**
+ Knowledge of leading competitive product offerings in the healthcare industry and marketplace standards and managed care knowledge strongly preferred.
For candidates working in person or virtually in the below locations, the salary* range for this specific position is $273,084 to $448,638.
Locations: Illinois, DC, and Nevada.
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
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