Credentialing Verification Specialist

Summary:

Under limited supervision, the Credentialing Verification Specialist (CVS) is responsible for maintaining credentialing and re-credentialing by thoroughly reviewing and verifying the credentials of licensed healthcare and behavioral health providers, such as doctors, dentists, physician assistants, nurse practitioners, social workers, CHA/Ps, and behavioral health therapists, to ensure they meet all necessary licensing, certification, and experience requirements to practice within a healthcare facility, by collecting primary source documentation, maintaining accurate records, and upholding compliance with relevant regulations and standards; essentially acting as a gatekeeper to verify that licensed professionals are qualified to provide patient care.

Essential Duties and Responsibilities:

• Process initial credentialing and re-credentialing applications for providers, carefully examining submitted documents like medical licenses, board certifications, malpractice insurance, and training certificates.
• Contact primary sources, such as medical schools, licensing boards, and hospitals, to verify the accuracy of information provided on applications.
• Maintain a comprehensive database of provider credentials, including expiration dates, ensuring information is updated and readily accessible.
• Stay abreast of changing regulations and standards related to healthcare credentialing, ensuring the facility adheres to all applicable laws.
• Perform quality checks on credentialing processes to identify potential errors or inconsistencies.
• Contact providers to request missing documentation, address concerns and provide updates on the credentialing process.
• The position serves as the head of the credentialing committee, which includes a representative from health services, community, and family services, as well as the Human Resources Director.
• Prepare reports and present findings to the credentialing committee for review and decision-making regarding provider privileges.
• Assist with internal and external credentialing audits, providing necessary documentation and addressing identified issues.
• Functions as primary contact for all internal and external inquiries for credentialing; develops and maintains positive working relationships.
• Release information to requesting agencies and public inquiries when required by law
• Performs other duties as assigned or required.

Qualifications:

• Completing a bachelor's degree from an accredited university in a related field, such as healthcare administration, business administration, health information management, and medical terminology.
• The position requires five years of experience directly related to the duties and responsibilities specified.
• A combination of related work experience and education demonstrating the ability to fulfill the position's functions may qualify as a degree substitute.
• The National Association of Medical Staff Services (NAMSS) offers certification programs to recognize professional achievements in medical services management and provider credentialing, such as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS). Must have certification or actively pursuing certification within one year of hire.

Physical Environment:

The following demands are representative of those that an employee must meet to perform the essential functions of this job successfully. The position requires the ability to sit for an extended period, a normal range of hearing and eyesight, eye-hand coordination, and manual dexterity to operate office equipment such as a computer keyboard, photocopier, telephone, and calculator. It may be required to lift approximately 30 pounds. Travel to remote locations by boat, snowmobile, ATV, or small plane is needed, and employees must be willing and able to travel.

Hours of Work:

The work hours are Monday to Friday, 8:30 a.m. to 5:00 p.m., with one hour for lunch. Chugachmiut maintains a drug/alcohol and non-smoking work environment.