Credentialing Specialist – Credentials Verification Organization

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee the application and data collection process for CVO providers, including application processing and Primary Source Verification (PSV).

• Assist with the onboarding and offboarding processes within the organization.

• Manage the execution of credentialing and re-credentialing applications along with their verification processes.

• Ensure that applications are complete and accurate, addressing any discrepancies in accordance with regulatory standards.

• Prepare necessary files and documents for review by the Medical Director, Credential Committee, and Medical Staff Office.

• Collaborate with credentialing auditors to rectify any deficiencies identified.

• Organize and maintain comprehensive provider data and documentation.

• Process applications efficiently while adhering to turnaround times, accuracy standards, CVO, and regulatory benchmarks.

• Ensure the accuracy of provider database information.

• Complete credentialing compliance checkpoints as required.

• Stay informed about TJC, NCQA, CMS, and other regulatory compliance guidelines.

• Communicate effectively with colleagues, customer relations, MSO representatives, and leadership to gather missing information and resolve issues.

• Uphold privacy and confidentiality standards.

⛳️ Requirements

• High School diploma or GED is mandatory.

• Preferred: 1 year of recent experience in medical staff services or a CVO environment.

• Preference for CPMSM or CPCS certification from NAMSS.

• Bachelor’s or Master’s degree in Business, Healthcare, or a related field is preferred.

• Strong preference for training in CredentialStream credentialing software.

• Understanding of relevant regulatory standards and primary source verification procedures is essential.

• Excellent professional communication skills are required.

• Ability to maintain privacy and confidentiality is crucial.

• Capability to meet turnaround times, accuracy, CVO, and regulatory benchmarks is necessary.

🏝️ Benefits

• Competitive salary.

• Incentives available.

• Referral bonuses offered.

• 403(b) plan with employer contributions (when eligible).

• Comprehensive medical, dental, vision, and prescription coverage.

• Options for HSA/FSA accounts.

• Life insurance provided.

• Access to mental health resources and discounts.

• Paid time off policy.

• Parental and FMLA leave available.

• Short- and long-term disability coverage.

• Backup care services for children and elderly family members.

• Tuition assistance programs.

• Support for professional development and continuing education.