Credentialing Specialist I

1 month ago

Roanoke, Virginia, United States Carilion Clinic Full time

How You'll Help Transform Healthcare:


Serves as supportive point of contact for all reapplicants to the medical staff at any Carilion Clinic facility or Carilion Ambulatory Practice (CAP) by facilitating the reapplication process, updating database information and obtaining required documents for credentialing and privileging.

Assists Manager and Director of Carilion Centralized Verification Services (CCVS) and co-workers to carry out the duties of the CCVS Department.

Provides support and documentation of CCVS activities to fulfill duties and obligations in accordance with Bylaws/Policies/Procedures, and to meet requirements of regulatory agencies (TJC (The Joint Commission), NCQA, URAC, and CMS (Center for Medicare Services).


  • Assists Manager and Director of CCVS in coordination of all Carilion Credentialing and Verification Services activities; follows direction and acts on own initiative as required.
  • Process, update and review reappointment applications for completeness on employed, external, contracted and locum tenen providers and perform verification of credentials in a timely and accurate manner for facilities/entities of the Carilion Clinic and associated Health plans as needed.
  • Provides verification and/or copies of licenses, OIG sanctions; sends requests for licenses, life certificates, DEAs, insurance and board certifications; and provides reports of non renewals of licenses, DEAs, insurance and board certifications to all CCVS clients as appropriate.
  • Maintains tracking report of all reappointment applications currently being worked to manager.
  • Works with department chairs, section chiefs, directors, managers and/or lead providers to provide progress, changes, and feedback in relation to any provider
  • Accurate entry and updating of all applicants in credentialing software system and creating/rendering reports from software system
  • Reviews credentialing verification documentation to ensure that the file is complete, and any required explanatory materials are included.
Tracks and updates information on all providers and performs timely follow-up for outstanding documents. Provides additional information, clarification, and verifications to facilities/entities as requested. Disseminates information to appropriate Carilion Clinic facilities/entities and Health plans in accordance with established policies/procedures.

  • Assists with or perform other duties, often of an official or confidential nature, as directed by the Manager or Director, CCVS.

What We Require:

Education:
High school diploma with training in office and computer skills. Some college education preferred.

Experience:
Minimum of three (3) years office experience, preferably in Medical Staff Services, Centralized Verification Organization, and credentialing or similar activities

Licensure, certification, and/or registration:
Certified Provider Credentialing Specialist (CPCS) preferred, ability to gain certification within 4 years.

Other:
Very detail/results oriented. Computer proficient. Ability to problem solve. Team player. Good interpersonal, organizational, oral and written communication skills. On-job-training in JCAHO, NCQA, URAC credentialing guidelines and regulatory agency requirements.

About Carilion
This is Carilion Clinic ...

An organization where innovation happens, collaboration is expected and ideas are valued. A not-for-profit, mission-driven health system built on progress and partnerships. A courageous team that is always learning, never discouraged and forever curious.


Headquartered in Roanoke, Va., you will find a robust system of award winning hospitals, Level 1 and 3 trauma centers, Level 3 NICU, Institute of Orthopedics and Neurosciences, multi-specialty physician practices, and The Virginia Tech Carilion School of Medicine and Research Institute.

Carilion is where you can make your own path, make new discoveries and, most importantly, make a difference. Here, in a place where the air is clean, people are kind and life is good. Make your tomorrow with us.

Requisition Number:
147835

Employment Status:
Full time

Location:
CASB - Carilion Administrative Services Building

Shift:
Day

Shift Details:
M-F 8-5

Recruiter:

HAYLEY F OHL

Recruiter Email:
hcfieldcarilionclinic
For more information, contact the HR Service Center at
Equal Opportunity Employer

Minorities/Females/Protected Veterans/Individuals with Disabilities/Sexual Orientation/Gender Identity

Carilion Clinic is a drug-free workplace.

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