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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. 


  • 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.


  • 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:

  • 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