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.
Excellent attention to detail.
Excellent organizational, analytical, and both oral and written communication skills.
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.
Our compensation package includes a hourly wage range of $25.00-$30.00 per hour as well as a performance incentive bonus.
HealthStream offers a comprehensive benefits package to eligible employees, including: