Credentialing Verifier in Nashville at Parallon

Date Posted: 7/28/2019

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    Nashville
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:
    7/28/2019

Job Description

(This is a 32 hour position)


JOB TITLE: Credentialing Verifier
 
GENERAL SUMMARY OF DUTIES – Responsible for credentialing collection and verification 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 and procedures. As requested, will be expected to assist with other tasks/ projects. Compliance with HCA policy and procedures, Federal and State regulatory and accrediting agencies is required.
SUPERVISOR – CPC Manager
SUPERVISES - None
DUTIES INCLUDE BUT ARE NOT LIMITED TO:
 Receive requests for Provider Action Forms (PAFs), Requests for Consideration (RFCs), and Reappointment Requests for Consideration (RRFCs and determine whether provider is already in Cactus system
 Compile RFC and RRFC packets in Cactus
 Responsible tracking of all RFC and RRFC packets and correspondence and maintaining documentation as requested
 Manual data entry of information into Cactus system for credentialing and recredentialing processes and data/image maintenance processes
 Accurately perform a variety of administrative duties such as: data/image review, verifying data, placing calls, processing incoming data/images, processing facsimile verifications, scanning, sending written inquires, filing, copying, and other duties as needed.
 Review RFC and RRFC packets for completeness of information, identify missing information
 Pursue incomplete information and documents
 Assure correct verifications obtained based on specific provider’s data and CPC policy and procedures, including but not limited to: state license(s), Federal and State DEA(s), board certification, education, and peer references.
 Prepare, scan, attach, send correspondence, and receive correspondence of credentialing and recredentialing data and images within RFC and RRFC documents for process review
 Assure timeliness of process completion
 Assure confidentiality of data
 Ensure that all provider data/images are current and complete pursuant to expiration date per CPC policy and procedures.
 Advise Credentialing Specialist 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 and works on special projects as requested.
 
KNOWLEDGE, SKILLS & ABILITIES
 Organization – proactively prioritizes needs and effectively manages resources. Ability to show attention to detail.
 Communication – communicates clearly and concisely. Must have excellent interpersonal and written communication skills. This includes spelling and grammar skills and basic mathematical calculations.
 Customer orientation – establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations.
 Policies & Procedures – articulates knowledge and understanding of organizational policies, procedures, and systems.
 PC Skills – demonstrates proficiency in Microsoft Office (Excel, Access, Word), Cactus, and HCO applications and other as required.
 Ability to maintain confidentiality of privileged information gained.
 Ability to work independently, in teams, and under pressure.
 Credentialing & Privileging technical skills –credentialing process and primary source verification knowledge.
 
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. Basic knowledge of credentialing processes and standards preferred
 Typing speed as follows: Intake, Dynamics, Correspondence, On-line: 25 wpm; Data Integrity Keyer: 40 wpm.
 Completion of post Cactus training testing of 80% or greater
 Understanding of professional telephone etiquette
 Able to work with minimal supervision and works well in both individual and group environment
 
PHYSICAL DEMANDS/WORKING CONDITIONS - 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.