Credentialing Specialist - Centralized Verification Office; Remote

Description

Peace Health 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 Peace Health 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.

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 Peace Health 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 Peace Health.

• Initiates, coordinates, processes and monitors initial appointment and reappointment credentialing applications in accordance with Peace Health 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 Peace Health 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 Peace Health 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 Peace Health medical staff offices and practitioners regarding credentials files and processes. Provides verification of Peace Health 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 Peace Health 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 Peace Health CVO policies and procedures.
• Performs other duties as assigned.

• 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.

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

• Preferred:
  Certified Provider Credentialing Specialist
• Preferred:
  Certified Professional Medical Services Management

• 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.…