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Sr. Credentialing Specialist Certified - VerityStream at Healthstream Inc. in San Diego, California

Posted in General Business 30+ days ago.

Type: Full-Time





Job Description:

Responsible for coordinating, monitoring and maintaining the credentialing and recredentialing verification services for healthcare organizations contracted with the CVO. Responsible for the accuracy and integrity of the file product. 

ESSENTIAL DUTIES OR RESPONSIBILITIES –


  • Reviews provider applications for completeness according to company policy and client criteria.

  • Confirms all required verification and data collection elements are received.

  • Completes all electronic verifications. Identifies “in-error” query transactions, obtains/corrects the applicable provider data, and re-request the transaction.

  • Tracks history of provider files.

  • Ensures PSV verification adheres to proper standards by supplying required information.

  • Confirms all information received from sources matches data in CVO database and on the provider application.

  • Processes, posts, and scans verification documents.

  • Expedites requests for verification according to client criteria and COL 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 biannual NCQA audits and job related projects as necessary.

KNOWLEDGE/EDUCATION AND EXPERIENCE REQUIRED:


  • High School diploma or GED: advanced education is preferred.

  • 2 years of credentialing experience in a medical group, acute care hospital, surgery center setting or other healthcare setting. 

  • CPMSM or CPCS certification required.

  • Experience with credentialing software.

  • Familiarity with accrediting bodies such as NCQA, JC or AAAHC standards as they relate to credentialing.

SKILLS REQUIRED:


  • Excellent attention to detail.

  • Excellent organizational, analytical, and both oral and written communication skills.

ABILITIES REQUIRED:


  • 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.

Compensation

Our compensation package includes a hourly wage range of $25.00-$30.00 per hour as well as a performance incentive bonus.

Benefits

HealthStream offers a comprehensive benefits package to eligible employees, including:


  • 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