Credentials Coordinator

HEALTHSTREAM INC•Nashville, TN

13d•$22 - $24•Hybrid

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.

Nice To Haves

Previous work history and years of experience may be considered in lieu of education requirement.

Responsibilities

Adhering to all HealthStream security policies, procedures, and assigned training.
Coordinating the provider application and primary source verification process using the CVO credentialing platform.
Managing the provider application process, including sending electronic applications, evaluating completeness, resolving incomplete information, and accepting information into the credentialing platform.
Communicating with applicants and designated administrative support to resolve application requirements and incomplete data professionally.
Managing primary source verifications for provider applications, ensuring accuracy and verification from primary sources, tracking fees, following up on missing verifications, and tracking information.
Communicating professionally with applicants, designated administrative support, and primary source organizations regarding verification discrepancies and information needs.
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 they are applied to files throughout the application and verification process.
Communicating with providers and clients regarding questions and concerns related to credentialing application processing.
Tracking and obtaining fee verifications; following department policies and procedures 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 professional growth through participation in seminars, conferences, in-service programs, and self-directed learning activities.
Contributing to team efficiency by providing support both operationally and administratively.
Assisting with special projects and tasks as requested.