Role Description Supports the CVO’s application process, credentialing verification, expirable management and ongoing monitoring work for contracted healthcare organizations. Ensures clients and providers have a positive experience by providing quality service and communication.

Key Responsibilities

• Coordinates provider application and primary source verification process using CVO credentialing platform.
• Manages provider application process including sending electronic applications to providers per client requests, evaluating the received application for completeness, resolving incomplete application information, accepting information into credentialing platform following CVO policies and procedures.
• Communicates with applicants and designated administrative support to resolve application requirements and incomplete data in a professional manner.
• Manages primary source verifications for provider applications including ensuring the verification of credentialing information from the provider’s application is correct and from primary sources, tracking fees for verifications, following up on non-received verifications needed to close files, and tracks information following CVO policies and procedures.
• Communicates professionally with applicants, designated administrative support and primary source organizations on verification discrepancies, information needs and requirements.
• Manages ongoing expirables for providers primary state license, board certification, DEA/CDS and malpractice insurance for contracted clients.
• Manages ongoing monitoring of sanctions for contracted clients for state licenses, Medicare and Medicaid and Medicare Opt-Out. Provides a monthly report of outcomes.
• Stays informed on all client criteria requirements to ensure requirements are applied to files through the application and verification process.
• Communicates with providers and client questions and concerns regarding a variety of issues related to the processing of credentialing applications.
• Tracks and obtains fee verifications; follows department policies and procedures standards for check requests and credit card usage.
• Supports the billing process for verification services.
• Maintains and updates the database reference tables in accordance with internal policies and procedures with current contact information following data standardization protocols.
• Maintains own professional growth through participation in seminars, conferences, in-service programs and self-directed learning activities.
• Contributes to the team efficiency by providing support both operationally and administratively.
• Assists with special projects and tasks as requested.

Qualifications

• Associate’s degree preferred. In lieu of education requirement, previous work history and years of experience may be considered.
• 1-3 years job related experience, preferably in a provider credentialing environment, a provider network or medical group.
• General knowledge and understanding of healthcare regulatory agencies NCQA, JC and AAAHC.
• 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.

Requirements

• Computer proficiency and accuracy in data entry.
• Ability to organize and prioritize work and manage multiple priorities.
• Ability to work in a fast-paced environment.
• Applies data integrity standards to the entry of application information.
• Excellent attention to detail.
• Excellent organizational, analytical, and both oral and written communication skills.
• Competent in Microsoft Office, Teams, Word, Excel and Outlook.
• Strong written and verbal communication skills and competence to communicate effectively to internal and external customers.
• Sound judgment and decision-making skills.
• Understands and applies department policies and procedures associated with medical credentialing.
• Focuses on customer satisfaction; identifies opportunities for creating efficiencies or improvements.
• Dependable and a strong work ethic.
• 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.
• This position is primarily sedentary in a normal office environment.
• Extensive computer usage and use of the phone.
• Could lift up to 20 lbs.
• Accountability - Taking responsibility for one’s actions and the consequences that result from those actions.
• Communication & Positive Presence - Listening attentively and respectfully; expressing thoughts and ideas effectively and concisely—both verbally and in writing. Exhibiting a pleasant attitude.
• Collaboration - Cooperating and working effectively with others in the pursuit of common goals.
• Problem Solving - Using sound judgment, logic, and common sense to identify and/or resolve issues that involve clients/customers, products, and processes.
• Adaptability - Being flexible and continuing to function effectively during times of change.
• Organizing - Using effective methods for tracking project details, time, and resources in order to complete tasks efficiently and in a timely manner.
• Quality Focus - Acting diligently to ensure all aspects of work are completed accurately.
• Customer Service - Treating clients/customers with a high level of respect and taking action in order to meet or exceed expectations and resolve problems.

Benefits

• 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.