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Credentialing Verifier (32 hour) in Nashville at Parallon

Date Posted: 2/22/2019

Job Snapshot

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Job Description

Parallon believes that organizations that continuously learn and improve will thrive. That’s why, after more than a decade, we remain dedicated to helping hospitals and hospital systems operate knowledgeably, intelligently, effectively and efficiently in the rapidly evolving healthcare marketplace, today and in the future. As one of the healthcare industry’s leading providers of business and operational services, Parallon is uniquely equipped to provide a broad spectrum of customized revenue cycle services.
***This is a 32 hour position***
GENERAL SUMMARY OF DUTIES – Responsible for credentialing activities as it relates to initial credentialing, re-credentialing, and credentials modification. Tracking of issues associated with activities necessary to maintain and document ongoing compliance with CPC policy. Will be expected to assist with other tasks/projects as requested. Compliance with HCA policy and procedure, Federal and State regulatory and accrediting agencies is required.
This OBCU Verifier is part of the CPC’s Outbound Call Unit. Responsibilities include making a high number of outbound phone calls each day to providers, facilities, universities, medical staffing offices, etc., to obtain missing items required to credential the provider. This includes working/completing a daily assignment spreadsheet of approximately 30 provider files, making outgoing calls, and performing extensive follow up. All work must be accurately documented in a contact log and all images must be reviewed and attached to the correct provider record in Cactus. Excellent communication skills, both written and verbal, are required. Prior experience in a call center, telemarketing, or collections type environment preferred. Strong computer skills is a must, along with the ability to search the internet for additional information and follow up. Must successfully complete Cactus training and score 90% on the Cactus test (Cactus is the CPC’s provider database.) Will be expected to assist the Manager and Director with other tasks/projects as requested. Compliance with HMA policy and procedure, Federal and State regulatory and accrediting agencies is required. Must have a positive attitude, be a team player, dependable, and professional, and arrive/depart to and from according to scheduled hours.
• Manual entry of practitioner data
• Review of practitioner data
• Assist in verifying data
• Primary Source Verification of select items
• Input on performance improvement for processes and documentation
• Assist with scheduling meetings, clerical support and other duties as requested
• Receive requests for applications
• Compile application and send to practitioner
• Responsible for intake and tracking of all applications and correspondence and maintaining documentation as requested
• Assist in the credentialing process by data entry of information into credentialing system for initial, updated, add on applications and maintenance processes
• Accurately perform a variety of administrative duties such as: placing calls, processing incoming mail, processing facsimile verifications, scanning, sending written inquires, filing, copying, and other duties as needed
• Review for completeness of information, identify deficiencies
• Pursue incomplete information
• Process and maintain credentialing and recredentialing in accordance with CPC policy and procedure, Joint Commission standards, State and Federal Regulatory regulations
This will include but not limited to the following verifications:
National Practitioner Data Bank OIG/GSA for Medicare/Medicaid exemption
DEA Verification Licensure
Board Certification
• Prepare credentialing and recredentialing applications for process review
• Assure timeliness of process completion
• Assure confidentiality of data
• Ensure that all credentials files are current and complete pursuant to expiration date of medical licenses, board certification, professional-liability insurance coverage, DEA and other pertinent information, per CPC policy
• Maintain high quality, timely and accurate credentialing processes of medical and allied healthcare professionals per CPC policy
• Advise Credentialing Coordinator of questionable information received and any issues identified during the processes
• Compliance with HCA policy and procedure, Federal and State regulatory and accrediting agencies as required
• Practice and adhere to the "Code of Conduct" philosophy and "Mission and Value Statement"
  Perform other duties as assigned
• High School Graduate or GED. Associate degree or an equivalent combination of education and experience preferred.
• At least 1 year previous office experience including data entry, typing, and basic computer usage and proficient keyboard and PC skills preferred.
• Previous Credentialing experience preferred. Must have basic knowledge of the Credentialing process and standards.
• Typing speed 50 words per minute.
• Completion of post Cactus training testing of 90% or greater.
• Understanding of professional telephone etiquette.
• Able to work with minimal supervision and works well in both individual and group environment.
CERTIFICATE/LICENSE - NAMSS certified as CPCS preferred