Credentialing Specialist

Position Overview Responsible for coordinating, monitoring and maintaining the credentialing and recredentialing services for healthcare organizations contracted with the CVO. Responsible for the accuracy and integrity of the file product. Key Responsibilities Reviews provider applications for completeness according to company policy and client criteria. Confirms all required verification and data collection elements are received. Tracks history of provider files. Confirms all information received from sources matches data in CVO database and on the provider application. Processes, corrects, scans, and posts verification documents for all verification types including electronic, websites, email, fax, and manual, ensuring they adhere to proper accreditation and CVO standards Expedites requests for verification according to client criteria and CVO policy. Identifies possible adverse issues that require additional investigations and evaluations, validates discrepancies and ensures appropriate follow up. Performs quality audit of 100% of files prior to closure and return to client. Interacts with client regarding any quality issues. Maintains familiarity with interpretation and compliance with the appropriate accrediting agencies, to include but not limited to NCQA, AAAHC and JC standards as they relate to client contract terms. Assists with preparation and compliance with NCQA audits. Maintains own professional growth through participation in seminars, conferences, in-service programs and self-directed learning activities. Assists with special projects and tasks as requested. Qualifications (Requirements) Bachelor’s degree preferred. In lieu of education requirement, previous work history and years of experience may be considered. CPCS or CPMSM certification within three years of hire. 2 or more years job related experience in a provider credentialing environment, a provider network or medical group. Experience with credentialing software. Working knowledge and understanding of healthcare regulatory agencies NCQA, JC and AAAHC. Working knowledge of credentialing requirements as related to medical providers. Working knowledge of the health care industry including hospital settings, physician practices, surgery centers and managed care organizations. Knowledge and experience in Microsoft Office applications. Additional Qualifications Computer proficiency and accuracy in data entry. Ability to organize and prioritize work and manage multiple priorities. Ability to work in a fast-paced environment. Applies data integrity standards to the review of application information. Excellent attention to detail. Excellent organizational, analytical, and both oral and written communication skills. Competent in Microsoft Office, Teams, Word, Excel and Outlook. Strong written and verbal communication skills and competence to communicate effectively to internal and external customers. Sound judgment and decision-making skills. Understands and applies department policies and procedures associated with medical credentialing. Applies data integrity standards to application and verification information. Focus on customer satisfaction; identifies opportunities for creating efficiencies or improvements. Dependable and a strong work ethic. Must be able to work well independently and exercise independent judgment. Must have the ability to understand and apply policies and procedures and regulatory standards associated with medical credentialing. This position is primarily sedentary in a normal office environment. Extensive computer usage and use of the phone. Could lift up to 20 lbs. Accountability - Taking responsibility for one's actions and the consequences that result from those actions. Communication & Positive Presence - Listening attentively and respectfully; expressing thoughts and ideas effectively and concisely—both verbally and in writing. Exhibiting a pleasant attitude. Collaboration - Cooperating and working effectively with others in the pursuit of common goals. Problem Solving - Using sound judgment, logic, and common sense to identify and/or resolve issues that involve clients/customers, products, and processes. Adaptability - Being flexible and continuing to function effectively during times of change. Organizing - Using effective methods for tracking project details, time, and resources in order to complete tasks efficiently and in a timely manner. Quality Focus - Acting diligently to ensure all aspects of work are completed accurately. Customer Service - Treating clients/customers with a high level of respect and taking action in order to meet or exceed expectations and resolve problems. Compensation The salary range for this position is $23.92 - $25.45 hourly. Salary will be determined on the candidate’s level of experience and qualifications. Compensation will be commensurate with skills, relevant experience, and performance in similar roles. Benefits Medical, Dental and Vision insurance Paid Time Off Parental Leave 401k and Roth Flexible Spending Account Health Savings Account Life Insurance Short- and Long-Term Disability Medical Bridge Insurance Critical Illness Insurance Accident Insurance Identity Protection Legal Protection Pet Insurance Employee Assistance Program Fitness Reimbursement HealthStream is an equal opportunity employer. HealthStream prohibits employment practices that discriminate against individual employees or groups of employees on the basis of age, color, disability, national origin, race, religion, sex, sexual orientation, pregnancy, veteran or military status, genetic information or any other category deemed protected by state and/or federal law. Req #45818 #J-18808-Ljbffr HealthStream