Credentialing Verifier in Orange Park at Parallon

Date Posted: 6/7/2019

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 85% 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