Credentialing Specialist

Corvel Richmond , VA 23234

Posted 3 months ago

JOB SUMMARY:

The Credentialing Specialist is responsible for the data integrity of CorVel's provider credentialing database and contributes to the best possible patient experience by helping to ensure that providers in the CorVel network meet all established federal and state standards as well as National Committee for Quality Assurance (NCQA) standards.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:

  • Primary Source Verification Obtain verification of license, education, certification, accreditation and other elements provided on facility and practitioner credentialing applications.

  • Alert Triage and Handling - Manage alert queue for incoming work. Including application download and credentialing complete notification.

  • Correspond with provider and PPO staff for missing items required for file completion and follow up on a regular basis.

  • File preparation Review NPDB, malpractice history, and sanctions. Summarize any issues to be presented to the committee. Copying issue file to committee folder.

  • Location updates Updating the credentialing database with demographic updates including location updates and terminations.

  • Merges Handling duplicate entries caused by the database with demographic updates including location updates and terminations.

  • Research/standards Investigating new sites for primary source verification. Keeping up to date with credentialing standards, credentialing program, and standard operating procedures.

  • Requires regular and consistent attendance

  • Complies with all safety rules and regulations during working hours in conjunction with the Injury and Illness Prevention Program ("IIPP").

  • Additional projects and duties as assigned.

KNOWLEDGE & SKILLS:

  • Excellent written and verbal communication skills.

  • Ability to learn rapidly to develop knowledge and understanding of federal and state standards as well as the credentialing practice.

  • Ability to identify, analyze and solve problems.

  • Computer proficiency and technical aptitude with the ability to utilize MS Office including Excel spreadsheets

  • Strong interpersonal, time management and organizational skills.

  • Ability to work both independently and within a team environment.

EDUCATION/EXPERIENCE:

  • Bachelor's degree or a combination of education and equivalent relevant experience.

  • Minimum 1 year experience in credentialing

Application Instructions:

We are an Equal Opportunity Employer. All persons shall have the opportunity to be considered for employment without regard to their race, color, age, sex, gender, religion, national origin, ancestry, citizenship status, physical or mental disability, military service, veteran status or any other characteristic protected by applicable federal, state or local law.

We will endeavor to make a reasonable accommodation to the known physical or mental limitations of a qualified applicant with a disability unless the accommodation would impose an undue hardship on the operation of our business. If you believe you require such assistance to complete this application or to participate in an interview, please let us know.

Note to Employment Agencies: Please do not forward agency resumes. CorVel Corporation is not responsible for any fees related to unsolicited resumes.

Please be aware that CorVel generally does not review all applications/resumes submitted in response to job openings posted on the Internet because of the large volume of responses


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Credentialing Specialist

Corvel