Credentialing Verifier Intake/Mail in Houston, TX at Parallon

Date Posted: 6/24/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    Houston, TX
  • Job Type:
    Other
  • Experience:
    Not Specified
  • Date Posted:
    6/24/2018

Job Description

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.

 

TRANSITION DUTIES INCLUDE BUT ARE NOT LIMITED TO

  • 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

DUTIES INCLUDE BUT ARE NOT LIMITED TO

  • 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 re*credentialing 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


Job Requirements

EDUCATION 

High School Graduate or GED. Associate degree or an equivalent combination of education and experience preferred.

 

EXPERIENCE

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