Credentialing Specialist

Job Location

Remote Type

Education Level

Travel Percentage

Job Category

As the #1 advisor for developing and empowering people to deliver the highest quality care, HealthStream’s brands include best-in-class apps, software, and specialized solutions. Over the last 30 years, our Company has remained committed to solving big problems and growing into new product lines, including VerityStream, scheduling and capacity management apps, and more. We are constantly innovating and finding new ways to positively impact healthcare organizations.

What does our values-based culture offer you?

• A collaborative work environment
• A mission-oriented mindset
• Work-from-home flexibility
• A chance to grow your career

All our HealthStreamers share a common vision: to improve the quality of healthcare by developing the people who deliver care. For over 30 years, we have remained committed to providing effective solutions through innovation and constant growth. Today, we offer a unified suite of products to streamline scheduling, credentialing, training and learning management, workforce development, and other key areas in the healthcare industry. We provide recurring value and, as a HealthStreamer, you will be at the forefront of healthcare technology innovation!

We offer work-from-home flexibility as part of our hybrid workplace policy. Our three Resource Centers (located in Nashville, TN; Boulder, CO; and San Diego, CA) are available for scheduled in-person events or assigned workspaces for those who want to work in the office. Remote team members also have access to flexible space scheduling for occasional use.

We encourage collaboration and commit to growth for our entire team. Our thriving culture allows our team members to continuously solve big problems, and we value these contributions. If you want to work for a company committed to its values and vision, HealthStream is the place for you!

The Team You Will Be Supporting:

At HealthStream we provide healthcare organizations:

• Transformative credentialing
• Enrollment
• Privileging
• Evaluation solutions

We make sure patients receive competent care from qualified people. As a HealthStream team member, you would help this vision come to life. We pride ourselves on being a community where you can both build your career and take time away to fulfill your life goals and commitments.

Your Role As a HealthStreamer

Position Summary

The Credentialing Specialist is responsible for coordinating, monitoring and maintaining the credentialing and recredentialing verification services for healthcare organizations contracted with the CVO. Responsible for the accuracy and integrity of the file product.

Essential Duties and Responsibilities

• Reviews provider applications for completeness according to company policy and client criteria.
• Confirms all required verification and data collection elements are received.
• Completes all electronic verifications. Identifies “in-error” query transactions, obtains/corrects the applicable provider data, and re-request the transaction.
• Tracks history of provider files.
• Ensures PSV verification adheres to proper standards by supplying required information.
• Confirms all information received from sources matches data in CVO database and on the provider application.
• Processes, posts, and scans verification documents.
• Expedites requests for verification according to client criteria and COL policy.
• Identifies possible adverse issues that require additional investigations and evaluations, validates discrepancies and ensures appropriate follow up.
• Performs quality audit of 100% of files prior to closure and return to client.
• Interacts with client regarding any quality issues.
• Maintains familiarity with interpretation and compliance with the appropriate accrediting agencies, to include but not limited to NCQA, AAAHC and JC standards as they relate to client contract terms.
• Assists with preparation and compliance with biannual NCQA audits and job related projects as necessary.

What You Will Need to Be Successful

Education, Experience, and Knowledge Required

• High School diploma or GED: advanced education is preferred.
• 2 years of credentialing experience in a medical group, acute care hospital, surgery center setting or other healthcare setting.
• CPMSM or CPCS certification. If not certified at the time of hire, certification must be obtained within two (2) years.
• Experience with credentialing software.
• Familiarity with accrediting bodies such as NCQA, JC or AAAHC standards as they relate to credentialing.

Skills and Abilities Required

• Excellent attention to detail.

• Excellent organizational, analytical, and both oral and written communication skills.
• 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.

Compensation

Our compensation package includes a base salary of $22-26 per hour as well as a performance incentive bonus.

Benefits

HealthStream offers a comprehensive benefits package to eligible employees, including:

• Medical, Dental and Vision insurance

• Paid Time Off
• Parental Leave

• 401k and Roth
• Flexible Spending Account
• Health Savings Account
• Life Insurance
• Short- and Long-Term Disability

• Medical Bridge Insurance
• Critical Illness Insurance
• Accident Insurance
• Identity Protection
• Legal Protection

• Pet Insurance
• Employee Assistance Program
• Fitness Reimbursement

If you have a passion for improving healthcare outcomes and empowering healthcare workers, come join the HealthStream team! We hope you join us and be a HealthStreamer!