Credentialing Coordinator at Healthstream Inc. in Nashville, Tennessee

Job Description:

POSITION SUMMARY:

Supports the CVO's credentialing verification work for contracted healthcare organizations. Obtains primary source verifications from organizations for the credentialing, recredentialing and expiring credentials activities. Provides technical support to department operations, functions and special projects.

ESSENTIAL DUTIES OR RESPONSIBILITIES:

• Contributes to the team efficiency by providing support both operationally and administratively.
• Ensures that the verification of credentialing information from the provider's application is correct and from primary sources.
• Alerts clients when there is a discrepancy of information between the application information and verification source.
• Keeps current expiring credentials on providers for primary state license, board certification, DEA/CDS and malpractice insurance for contracted clients.
• Researches non-received verifications required to close files. Contacts and communicates to verification sources and clients for needed information via phone, email or fax. Tracks and documents verification efforts.
• Updates provider data with verification responses from entities and organizations in accordance with internal policies and procedures.
• Inputs credentialing data into the database from provider applications and other source documents correctly and accurately. Follows department standards for data entry and data standardization protocols.
• Scans and appends verifications and documentation to provider files.
• Applies clients' contracted verification criteria requirements to the credentialing and recredentialing of files.
• Performs other department verification and operational tasks as needed.

JOB SPECIFICATIONS:

A. KNOWLEDGE/EDUCATION AND EXPERIENCE REQUIRED:

• Associates degree in health administration or a related field; or high school diploma, or GED and two-years experience in a healthcare environment, preferably in credentialing.
• CPCS or CPMSM preferred; or CPCS or CPMSM certification within three years of hire.
• General knowledge and understanding of healthcare regulatory agencies.
• General knowledge of credentialing requirements as related to medical providers.
• General knowledge of the health care industry including hospital settings, physician practices, surgery centers and managed care organizations.
• Knowledge and experience in Microsoft Office applications.

• Computer proficiency and accuracy in alpha and numeric data entry.
• Ability to organize and prioritize work and manage multiple priorities.
• Ability to work in a fast-paced environment.
• Reads, speaks, understands and writes English.
• Could lift up to 20 lbs.

• Strong communication skills including the ability to correspond effectively as well as verbally.
• Uses sound judgment and decision making skills.
• Understands and applies department policies and procedures and regulatory standards associated with medical credentialing.
• Applies data integrity standards to verification information.
• Focus' on customer satisfaction; identifies opportunities for creating efficiencies or improvements.
• Dependable and a strong work ethic.