Credentialing Specialist - Centralized Verification Office (Remote)

Description

PeaceHealth is seeking a Credentialing Specialist - Centralized Verification Office (Remote) for a Full Time, 1.00 FTE, Day position. The salary range for this job opening at PeaceHealth is $24.30 - $36.42. The hiring rate is dependent upon several factors, including but not limited to education, training, work experience, terms of any applicable collective bargaining agreement, seniority, etc.

Job Summary :

Responsible for coordinating, processing, monitoring and maintaining the initial and reappointment confidential credentialing processes for medical staff and allied health practitioners, ensuring timeliness and compliance with PeaceHealth standards and criteria as well as all legal, regulatory and accreditation requirements. Perform primary source verification according to established policies. Responsible for the accuracy and integrity of the credentialing database system. Coordinates payer enrollment service processes for governmental and non-delegated third-party payers for Providers associated with PeaceHealth.

Details of the Position :

Initiates, coordinates, processes and monitors initial appointment and reappointment credentialing applications in accordance with PeaceHealth policies and timelines as well as legal, regulatory and accreditation requirements; maintains tracking mechanisms.

Gathers, verifies and evaluates healthcare provider credentials for initial and recredentialing applications; identifies potential issues; determines if further investigation or information is necessary and makes appropriate inquiries; assesses completed applications to ensure PeaceHealth criteria are met and all necessary elements are present and correct. Works with practitioners to ensure smooth and timely credentialing process.

Performs and maintains tracking system to monitor expirables on an ongoing basis; verifies renewals; ensures all credentialed providers within the PeaceHealth system have current expirables at all times in accordance with regulatory and accreditation requirements; maintains accurate records to document compliance for surveys and audits.

Enters and maintains data in the credentialing database according to established data entry rules, policies and procedures.

Maintains credentials files and related records. Processes application requests from contracted entities; ensures correct application forms and complete packets are sent to provider.

Communicates with PeaceHealth medical staff offices and practitioners regarding credentials files and processes. Provides verification of PeaceHealth membership and clinical privileges for current and former credentialed providers as requested by internal or external organizations; maintains database and other records.

Processes credentialed provider demographic changes as requested by PeaceHealth contracted entities; process resignations according to established policies and procedures.

Provide verification of hospital medical staff membership to outside entities according to established policies and procedures.

Maintain general knowledge of PeaceHealth CVO policies and procedures.

Performs other duties as assigned.

What You Bring : Education

High School Diploma Required : or equivalent

Business School Required : Medical Staff Or

Business School Required : Health Information Technology or equivalent combination of education and experience that provides the requisite knowledge, skills and abilities to perform the job.

Experience

• Minimum of 2 years Required : Credential verification or healthcare administration

Credentials

Preferred : Certified Provider Credentialing Specialist

Preferred : Certified Professional Medical Services Management

Skills

Excellent critical thinking and problem-solving skills. (Required)

Detail oriented with demonstrated accuracy, organizational and time management skills. (Required)

Working knowledge of credentialing database software; Verity Credential Stream software. (Preferred)

Knowledge of legal, regulatory and accreditation credentialing requirements. (Preferred)

Proficiency in MS Office applications, i.e., Word, Excel, etc. (Required)

Excellent verbal and written communication skills. (Required)

Excellent customer service skills. (Required)

Ability to support multiple priorities, projects and display flexibility in a fast paced and challenging work environment. (Required)

Knowledge of medical terminology. (Preferred)

Working Conditions : Lifting

Consistently operates computer and other office equipment.

Exerting up to 10 pounds of force occasionally and / or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects.

Sedentary work.

Environmental Conditions

Predominantly operates in an office environment.

Some time spent on site in medical / hospital setting.

Mental / Visual

Ability to communicate and exchange accurate information.

The worker is required to have close visual acuity to perform an activity such as : preparing and analyzing data and figures; transcribing; viewing a computer terminal; extensive reading.

PeaceHealth is committed to the overall wellbeing of our caregivers : physical, emotional, financial, social, and spiritual. We offer caregivers a competitive and comprehensive total rewards package. Some of the many benefits included in this package are full medical / dental / vision coverage; 403b retirement plan employer base and matching contributions; paid time off; employer-paid life and disability insurance with additional buyup coverage options; tuition and continuing education reimbursement; wellness benefits, and expanded EAP and mental health program.

See how PeaceHealth is committed to Inclusivity, Respect for Diversity and Cultural Humility () .

For full consideration of your skills and abilities, please attach a current resume with your application. EEO Affirmative Action Employer / Vets / Disabled in accordance with applicable local, state or federal laws.

REQNUMBER : 122664