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Credentialing Verifier in Orange Park at Parallon

Date Posted: 1/3/2019

Job Snapshot

  • Employee Type:
  • Location:
    Orange Park
  • 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.
  • 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

  • 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.

  • 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