Credentialing Specialist

HEALTHSTREAM INC•Nashville, TN

4d•$24 - $25•Remote

About The Position

HealthStream is the leader in healthcare workforce solutions. We help organizations work better by helping their people work smarter. HealthStream provides the leading learning, clinical development, credentialing, and scheduling applications delivered on healthcare’s #1 platform. We streamline everyday tasks while improving performance, engagement, and safety – fostering a workplace where people flourish, and care thrives. Why Join Us At HealthStream, you’ll have the opportunity to make a meaningful impact on the future of healthcare by collaborating with a team of talented professionals dedicated to innovation and excellence. We offer competitive compensation, comprehensive benefits, and a supportive work environment where creativity and collaboration thrive. Our shared vision is to enhance the quality of healthcare by empowering the people who deliver care – a commitment we have upheld for over 30 years through providing innovative solutions and driving constant growth. Join us in revolutionizing the healthcare industry and shaping the future of patient care. As a HealthStreamer, you will be at the forefront of healthcare technology innovation, making a recurring impact on the industry. We’re proud of our values-forward culture that offers our people: Mission-oriented work Diverse and inclusive culture Competitive Compensation & Bonuses Comprehensive Insurance Plans Mental and Physical Health Support Work-from-home flexibility Fitness Center Reimbursements Streaming Good time off for volunteering Wellness workshops Buddy Program for new HealthStreamers Collaborative work environment Career growth opportunities Continuous learning opportunities Inspiring workspaces to collaborate and connect with other HealthStreamers Free employee parking at our Resource Centers in Nashville and San Diego At HealthStream, our thriving culture encourages collaboration and values contributions, allowing our team members to continuously solve big problems and grow. We offer flexibility and paid time off to support work-life integration for all employees, including a hybrid work environment and Streaming Good volunteer day. For team members in commutable distance, HealthStream has Resource Centers in Nashville, TN and San Diego, CA. Our resource centers provide an inspiring workspace to collaborate and recharge as well as company-sponsored onsite social events for development, connection, and celebration. We are committed to driving innovation in healthcare and ensuring that patients receive competent care from qualified professionals. As a HealthStream team member, you will help bring this vision to life. If you want to work for a company committed to its values and vision, HealthStream is the place for you! HealthStream is an equal opportunity employer. HealthStream prohibits employment practices that discriminate against individual employees or groups of employees on the basis of age, color, disability, national origin, race, religion, sex, sexual orientation, pregnancy, veteran or military status, genetic information or any other category deemed protected by state and/or federal law. Position Overview Responsible for coordinating, monitoring and maintaining the credentialing and recredentialing services for healthcare organizations contracted with the CVO. Responsible for the accuracy and integrity of the file product.

Requirements

Bachelor’s degree preferred. In lieu of education requirement, previous work history and years of experience may be considered
CPCS or CPMSM certification within three years of hire.
2 or more years job related experience in a provider credentialing environment, a provider network or medical group.
Experience with credentialing software
Working knowledge and understanding of healthcare regulatory agencies NCQA, JC and AAAHC.
Working knowledge of credentialing requirements as related to medical providers.
Working 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 review 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
This position is primarily sedentary in a normal office environment.
Extensive computer usage and use of the phone.
Could lift up to 20 lbs.
Accountability - Taking responsibility for one’s actions and the consequences that result from those actions.
Communication & Positive Presence - Listening attentively and respectfully; expressing thoughts and ideas effectively and concisely—both verbally and in writing. Exhibiting a pleasant attitude.
Collaboration - Cooperating and working effectively with others in the pursuit of common goals.
Problem Solving - Using sound judgment, logic, and common sense to identify and/or resolve issues that involve clients/customers, products, and processes.
Adaptability - Being flexible and continuing to function effectively during times of change.
Organizing - Using effective methods for tracking project details, time, and resources in order to complete tasks efficiently and in a timely manner.
Quality Focus - Acting diligently to ensure all aspects of work are completed accurately.
Customer Service - Treating clients/customers with a high level of respect and taking action in order to meet or exceed expectations and resolve problems.

Responsibilities

Reviews provider applications for completeness according to company policy and client criteria.
Confirms all required verification and data collection elements are received.
Tracks history of provider files.
Confirms all information received from sources matches data in CVO database and on the provider application.
Processes, corrects, scans, and posts verification documents for all verification types including electronic, websites, email, fax, and manual, ensuring they adhere to proper accreditation and CVO standards
Expedites requests for verification according to client criteria and CVO policy.
Identifies possible adverse issues that require additional investigations and evaluations, validates discrepancies and ensures appropriate follow up.
Performs quality audit of 100% of files prior to closure and return to client.
Interacts with client regarding any quality issues.
Maintains familiarity with interpretation and compliance with the appropriate accrediting agencies, to include but not limited to NCQA, AAAHC and JC standards as they relate to client contract terms.
Assists with preparation and compliance with NCQA audits.
Maintains own professional growth through participation in seminars, conferences, in-service programs and self-directed learning activities.
Assists with special projects and tasks as requested