Credentialing Specialist

Aiken Regional Medical Centers

Reno (NV)

On-site

USD 65,000 - 80,000

Full time

3 days ago

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Benefits offered by this job

Loan Forgiveness

Paid Time Off

Medical, Dental, Vision plans

401(K) with company match

SoFi Student Loan Refinancing

Career development opportunities

Job summary

Prominence Health, part of Universal Health Services, seeks a Credentialing Specialist to thoroughly investigate and verify credentials for practitioners and facilities contracted to serve Health Plan members. You will direct primary source verifications, resolve discrepancies, and summarize findings for the Medical Director and Plan Credentialing Committee.

You will ensure compliance with State, Federal and NCQA/CMS accreditation standards, maintain timely verifications, and support a compliant

Qualifications

High school diploma or equivalent.
1 – 3 years related experience.
Strong communication in English, both verbally and in writing with provider applicants, applicants’ staff, the Medical Director, the Credentialing Committee, and other departments within the organization both verbally and in writing
Must be highly detail oriented and requires strong organizational and prioritization skills, as well as the ability to complete job responsibilities of a confidential nature, with significant accountability and accuracy to meet established timelines
One year physician office or related medical care experience required. Medical staff office experience preferred.
Credentialing experience strongly preferred.
Excellent computer skills including word-processing, databases, spreadsheets and graphics.
Well-developed professional interpersonal written and oral communication skills.
Strong medical terminology recommended.
Strong organizational skills with the ability to prioritize multiple tasks/projects using established protocols and guidelines to determine the appropriate course of action and meet established timelines.
Strong customer service skills that contribute to a customer-oriented team and department.
Motivated, flexible, and a self-starter.
Requires assertiveness, creativity and good problem-solving skills.

Responsibilities

Conduct thorough and accurate investigation of background and credentials for all practitioners and facilities contracted to provide care to Health Plan members.
Direct and oversee primary source verification of all credentialing elements and clarify discrepancies identified in the verification process.
Summarize and report investigation results to the Medical Director and Plan Credentialing Committee, with follow-up regarding credentialing determinations as required.
Ensure processes demonstrate compliance with State, Federal and National regulatory requirements and NCQA and CMS accreditation standards.

Skills

Communication skills

Detail oriented

Organizational skills

Customer service

English proficiency

Education

High school diploma or equivalent

Tools

Word processing

Databases

Spreadsheets

Graphics

Job description

Responsibilities

Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.

Learn more at: https://prominence-health.com/

Job Summary:

Position ensures thorough and accurate investigation of background and credentials for all practitioners and facilities contracted to provide care to Health Plan members. Position evaluates adequacy of information presented by all applicants for initial and re-credentialing, directing and overseeing primary source verification of all credentialing elements, and ensuring clarification of any discrepancies discovered in the verification process. Position accurately summarizes and reports the results of each investigation to the Medical Director and Plan Credentialing Committee, with written follow-up regarding credentialing determinations, as required. Position is also responsible for ensuring processes demonstrate compliance with State, Federal and National regulatory requirements and the accreditation standards of the National Committee for Quality Assurance (NCQA) and Medicare (CMS).

Benefit Highlights:

Loan Forgiveness Program
Challenging and rewarding work environment
Competitive Compensation & Generous Paid Time Off
Excellent Medical, Dental, Vision and Prescription Drug Plans
401(K) with company match and discounted stock plan
SoFi Student Loan Refinancing Program
Career development opportunities within UHS and its 300+ Subsidiaries! · More information is available on our Benefits Guest Website: benefits.uhsguest.com

About Universal Health Services:

One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; and listed in Forbes ranking of America’s Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com

Qualifications

Qualifications and Requirements:

· High school diploma or equivalent.

· 1 – 3 years related experience.

· Requires strong skills for communication in English, both verbally and in writing with provider applicants, applicants’ staff, the Medical Director, the Credentialing Committee, and other departments within the organization both verbally and in writing

· Must be highly detail oriented and requires strong organizational and prioritization skills, as well as the ability to complete job responsibilities of a confidential nature, with significant accountability and accuracy to meet established timelines

· One year physician office or related medical care experience required. Medical staff office experience preferred.

· Credentialing experience strongly preferred.

· Excellent computer skills including word-processing, databases, spreadsheets and graphics.

· Well-developed professional interpersonal written and oral communication skills.

· Strong medical terminology recommended.

· Strong organizational skills with the ability to prioritize multiple tasks/projects using established protocols and guidelines to determine the appropriate course of action and meet established timelines.

· Strong customer service skills that contribute to a customer-oriented team and department.

· Motivated, flexible, and a self-starter.

· Requires assertiveness, creativity and good problem-solving skills.

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.

Avoid and Report Recruitment Scams

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS

and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc.

If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.