Credentialing Specialist

A5 Healthcare one of one of the fastest-growing Credentialing Verification Organizations in the country is seeking a Credentialing Specialist who is motivated to learn, excited to collaborate and passionate about delivering outstanding results. This individual will have a direct impact on our firm’s mission of serving as a catalyst for those striving to achieve their highest potential. 

The Credentialing Specialist will be accountable for performing all the duties related to the requesting, receiving, processing, and primary source verifying applications for initial and reappointment for multiple facilities. This position will exemplify a culture of excellence, effective communication and collaboration, and customer service with CVO leadership and staff, internal and external customers and providers. Must handle, with discretion, issues that are significant, complex, multidisciplinary, sensitive, and confidential.

 

What You’ll Do:  

• Application management and verification activities, preliminary analysis of application and verification information, and analyzing verification information, to include identifying red flag and/or adverse information.
• Ability to research and analyze documents utilizing strong documentation skills with high attention to detail.
• Maintain timely communication with applicants and member organizations on the status of the application files and any required documents or information needed to complete the medical credentialing process.
• Monitoring expiring information such as, but not limited to, federal and state DEA, state professional license(s), professional liability insurance, and specialty board certification status.
• Timely and accurately prepare credential files for audit and submission to assigned facilities.
• Compliance with standard turn-a-round times.
• Maintain a working knowledge of relevant regulatory standards (i.e., TJC, AAAHC, DNV and NCQA), state and federal requirements and CMS.
• Assist with the development and implementation of credentialing and re-credentialing workflows to ensure efficient and effective alignment of processes and assist in the development or revision of credentialing related forms.
• Participation in special project teams as assigned.

What We’re Looking For:   

• Knowledge of credentialing software and associated applications.
• Experience with credentialing verification and application audit process.
• Ability to make decisions that are guided by general instructions and practices requiring some interpretation. May make recommendations for solving problems of moderate complexity and importance.
• Ability to address problems that are varied, requiring analysis or interpretation of the situation using direct observation, knowledge and skills based on general precedents.
• Ability to follow policies and procedures. May set priorities and organize work within general guidelines. Seeking assistance when confronted with difficult and/or unpredictable situations. Work progress is monitored by supervisor/manager.
• Ability to communicate clearly and effectively with internal and external customers.
• Ability to comprehend and converse to communicate effectively assigned facilities.
• Ability to demonstrate full working knowledge of standard concepts, practices, procedures and policies with the ability to use them in varied situations.
• Ability to work collaboratively in small teams to improve the operations of immediate work groups by offering ideas, identifying issues, and respecting team members.

Your Qualifications:  

• Associate Degree preferred, High School diploma or GED required.
• 3-5 years related work experience required in CVO or other credentialing setting.
• Certified Provider Credentialing Specialist (CPCS) required.
• Experience with computer systems required, including web-based applications and some Microsoft Office applications which may include Outlook, Word, -Excel, and credentialing database.

Please note, the compensation/salary range provided in this posting is an hourly pay range. 

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