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Credentialing Verifier in Orange Park at Parallon

Date Posted: 2/28/2019

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    Orange Park
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:
    2/28/2019

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.

SUPERVISOR – CPC Manager

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 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

KNOWLEDGE, SKILLS & ABILITIES
• Organization – proactively prioritizes needs. 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 – 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 (Outlook, Excel, Access, Word) applications and others as required.
• Ability to maintain confidentiality of privileged information gained.
• Ability to work independently 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. 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
 
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