Credentialing Coordinator

HEALTHSTREAM INC•Nashville, TN

1d•$22 - $24•Remote

About The Position

Supports the CVO’s application process, credentialing verification, expirable management and ongoing monitoring work for contracted healthcare organizations. Ensures clients and providers have a positive experience by providing quality service and communication.

Requirements

Associate’s degree preferred. In lieu of education requirement, previous work history and years of experience may be considered.
1-3 years job related experience, preferably in a provider credentialing environment, a provider network or medical group.
General knowledge and understanding of healthcare regulatory agencies NCQA, JC and AAAHC.
General knowledge of credentialing requirements as related to medical providers.
General knowledge of the health care industry including hospital settings, physician practices, surgery centers and managed care organizations.
Knowledge and experience in Microsoft Office applications.
Computer proficiency and accuracy in data entry.
Ability to organize and prioritize work and manage multiple priorities.
Ability to work in a fast-paced environment.
Applies data integrity standards to the entry of application information.
Excellent attention to detail.
Excellent organizational, analytical, and both oral and written communication skills.
Competent in Microsoft Office, Teams, Word, Excel and Outlook.
Strong written and verbal communication skills and competence to communicate effectively to internal and external customers.
Sound judgment and decision-making skills.
Understands and applies department policies and procedures associated with medical credentialing.
Applies data integrity standards to application and verification information.
Focus’ on customer satisfaction; identifies opportunities for creating efficiencies or improvements.
Dependable and a strong work ethic.
Must be able to work well independently and exercise independent judgment.
Must have the ability to understand and apply policies and procedures and regulatory standards associated with medical credentialing.

Responsibilities

Adhering to all HealthStream security policies, procedures, and assigned training.
Coordinating provider application and primary source verification process using CVO credentialing platform.
Managing provider application process including sending electronic applications to providers per client requests, evaluating the received application for completeness, resolving incomplete application information, accepting information into credentialing platform following CVO policies and procedures.
Communicating with applicants and designated administrative support to resolve application requirements and incomplete data in a professional manner.
Managing primary source verifications for provider applications including ensuring the verification of credentialing information from the provider’s application is correct and from primary sources, tracking fees for verifications, following up on non-received verifications needed to close files, and tracks information following CVO policies and procedures.
Communicating professionally with applicants, designated administrative support and primary source organizations on verification discrepancies, information needs and requirements.
Managing ongoing expirables for providers primary state license, board certification, DEA/CDS and malpractice insurance for contracted clients.
Managing ongoing monitoring of sanctions for contracted clients for state licenses, Medicare and Medicaid and Medicare Opt-Out.
Providing a monthly report of outcomes.
Staying informed on all client criteria requirements to ensure requirements are applied to files through the application and verification process.
Communicating with providers and client questions and concerns regarding a variety of issues related to the processing of credentialing applications.
Tracking and obtaining fee verifications; following department policies and procedures standards for check requests and credit card usage.
Supporting the billing process for verification services.
Maintaining and updating the database reference tables in accordance with internal policies and procedures with current contact information following data standardization protocols.
Maintaining own professional growth through participation in seminars, conferences, in-service programs and self-directed learning activities.
Contributing to the team efficiency by providing support both operationally and administratively.
Assisting with special projects and tasks as requested.