Job Description

Location: Corporate
Posted Date: 8/18/2020

POSITION SUMMARY:

Under the direction of the Director of the Credentialing Verification Office with daily activities supervised by the Credentialing Manager, this position performs all duties for processing initial and recredentialing medical provider applications per NCQA, The Joint Commission, DN-V, CMS, State and Federal regulations, and Medical Staff By-Laws. This is a remote working position. A laptop and required equipment will be furnished. High speed internet service is the responsibility of the applicant. Applicants must reside in: MA, AR, AZ, FL, GA, KS, KY, LA, MO, NC, NJ, NM, NY, OH, PA, SC, TN, TX, UT, WI for consideration.

KEY RESPONSIBILITIES:

Responsibilities include (but are not limited to):

  • Acts independently to process medical credentialing applications and the supporting documentation. Reviews the provider applications for completion and identifies the missing items and/or concerns. Request appropriate follow up information from the Medical Staff Office(s) or other sources as needed.
  • Reviews the primary source verifications for accuracy and notifications of reported items.
  • Coordinates the credentialing process for assigned providers.
  • Ensure files are maintained according to and all applicable governing agencies and internal quality and security policies, to include electronic document management. Needs to maintain an organized electronic filing system.
  • Collects and maintains all pertinent information from the provider. Communicates consistently with the Medical Staff Office or provider’s office contact in a timely and effective manner to follow up to obtain required documents timely in alignment with regulated processing guidelines.
  • Verifies all credentialing elements, including but not limited to, education, training, board certification, work history, licensure and certifications, malpractice coverage; through a variety of primary sources as deemed appropriate per NCQA, DN-V and TJC standards.
  • Enters data accurately and completely in the credentialing software.
  • Analyzes provider files for completeness, accuracy, consistency, gaps in work history, relevant references, etc. Identifies issues and initiates further data collection as needed. Communicates completion of the file to the appropriate Medical Staff Office or provider’s office.
  • Maintains thorough understanding of NCQA, TJC, DN-V and state(s) regulatory credentialing standards.
  • Responsible for the quality and integrity of provider files and meets processing quality and productivity standards.
  • Performs routine file audits.
  • Adheres to strict confidentiality requirements.
Other duties as assigned.

REQUIRED KNOWLEDGE & SKILLS:

  • Strong organizational, problem solving, and prioritization skills as demonstrated by the successful and timely completion of assignments.
  • Excellent verbal and written communication skills, ability to interact with all levels of personnel
  • Keen attention to detail
  • Experience working in a remote team-oriented, collaborative and matrix environment
  • Working knowledge of Microsoft Office, Teams/Webex/Zoom, Nitro PDF, and credential software

Preferred: Verity/Echo credentialing system or other comparable software used in daily tasks

EDUCATION/EXPERIENCE/LICENSURE/TECHNICAL/OTHER:

  • Education: Bachelor's degree or equivalent education and experience

  • Experience:
    • Three or more years of credentialing experience in a medical staff services department, CVO or managed care plan desired.
    • Experience with Initial and Reappointment file processing according to NCQA, DNV and TJC standards.
    • Preferred: NAMSS Certified Provider Credentialing Specialist Certification (CPCS)

This position is tele-commute.

Applicants must reside in: MA, AR, AZ, FL, GA, KS, KY, LA, MO, NC, NJ, NM, NY, OH, PA, SC, TN, TX, UT, WI for consideration.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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