Credentialing Verifier in Orange Park, FL at Parallon

Date Posted: 3/5/2018

Job Snapshot

  • Employee Type:
  • Location:
    335 Crossing Boulevard
    Orange Park, FL
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:

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.
  • 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                                                       
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

Job Requirements

  • 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.

Requires prolonged sitting, some bending, stooping and stretching.  Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment.  Requires normal range of hearing and eyesight to record, prepare and communicate appropriate reports.  Requires lifting papers or boxes up to 50 pounds occasionally.  Work is performed in an office environment.  Work may be stressful at times.  Contact may involve dealing with angry or upset people.