CVO Credentialing Specialists

Phoenix, AZ 85004

Job Category: Administrative & Professional Job Number: 20969

Job Description

The CVO Credentialing Specialist is responsible for credentialing and re-credentialing providers in the Network as well as ensuring enrollment with participating client health plans. Credentialing functions include, but are not limited to, processing credentialing/re-credentialing applications, performing primary source verification' s and updating and maintaining the Vistar eVIPs credentialing database in accordance with internal policies and procedures, client health plan contracts, URAC measures and standards and applicable state and federal regulations.

  • Efficiently perform all aspects of credentialing verification, including initial credentialing/re-credentialing to ensure valid and active credentials in accordance with URAC standards
  • Responsible for gathering and verifying highly confidential and sensitive health care practitioner credentials consistent with URAC measures and standards
  • Maintain appropriate communication with all group organization, client health plan and internal inquiries in a timely manner
  • Monitor expiring licensure, board and professional certifications and other expiring documents with practitioners within the prescribed timeframe
  • Manage practitioner data files for Q Point clients; utilize Vistar eVIPs and primary source databases to obtain and review practitioner data as required for the credentialing/recredentialing process
  • Responsible for accurate data entry to ensure the integrity of credentialing and demographic information in applicable database(s)
  • Use critical thinking skills to conduct follow-up with group organizations, internal and external entities to resolve discrepancies identified during the credentialing process
  • Conduct sanctions, compliance monitoring and alert Supervisor of any undisclosed negative findings immediately
  • Actively participate in team meetings and process improvement initiatives to continuously improve work productivity, quality and efficiency
  • Shared responsibility for reviewing, processing and distributing incoming correspondences (i.e., interdepartmental mail, fax and email)
  • Keep Supervisor informed of potential credentialing or verification issues
  • Other duties as assigned

Required Knowledge, Education & Experience:
  • Associate degree is preferred; or, an equivalent combination of education and/or experience
  • Minimum of three (3) years of experience with multi-specialty credentialing; experience should include responsibilities for primary source verifications and delegated credentialing requirements  that adhere to policies & procedures
  • Able to handle sensitive and confidential information with discretion  and trust
  • Excellent oral and written communication and interpersonal skills with efficient follow up
  • Demonstrated ability to work under pressure and be adaptable to growth and change
  • Proficiency with MS Office applications and web-based technologies

Highly Preferred Skills, Abilities & Qualifications:
  • Certified Provider Credentialing Specialist (CPCS)
  • Experienced with Credentialing MSO databases
  • Attention to detail and accuracy
  • Dedication to quality, teamwork and professionalism
  • Able to multi-task
  • Able to meet tight deadlines and respond to rapidly changing demands

Meet Your Recruiter

Laura Piel

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