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.

Responsibilities:
  • 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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