Credentialing Verifier II

HCA Healthcare; Houston (TX); On-site; USD 42,000 - 56,000; Full time

Benefits offered by this job

Medical, prescription, dental, vision

Behavioral health support

Paid time off and family leave

401(k) plan with match

Tuition assistance

Job summary

Parallon, part of HCA Healthcare, invites Credentialing Verifier II candidates to join a team that handles credentialing collection and verification for initial and re-credentialing. This role requires attention to detail and adherence to CPC policies, with daily tasks involving data entry, verifications, and documentation.

The Credentialing Verifier II position supports ensuring timely, accurate verifications across state and federal requirements, with a Monday–Friday, 40-hour schedule and

Qualifications

• Minimum 1 year of credentialing experience.
• High School Diploma or GED; associate degree preferred.
• Completion of credentialing assessments with 90%+.
• Professional telephone etiquette and verbal communication.
• Able to work with minimal supervision.

Responsibilities

• Subject Matter Expert on credentialing policies and systems.
• Process PAFs, RCFs and RRFCs; verify providers in Cactus.
• Create RFC/RRFC packets in Cactus and track status.
• Perform online verifications and data/image maintenance.
• Maintain confidential provider data and complete documentation.

Skills

Telephone etiquette

Data entry

Detail oriented

Independent worker

Education

High School Diploma or GED

Associate degree (preferred)

Tools

Cactus system

Document Management Outbound

Background check systems

Job description

Do you want to join an organization that invests in you as a Credentialing Verifier II? At Parallon, you come first. HCA Healthcare has committed up to $300 million in programs to support our incredible team members over the course of three years.

Candidate must live within 60 miles of a HCA facility in FL, GA, ID, KS, KY, MO, NC, NH, NV, SC, TN, TX, UT and VA.

Schedule: Monday- Friday, 40 Hour Work Week based on Business Needs.

Job Summary And Qualifications

The Credentialing Verifier II is responsible for credentialing collection and verification activities as it relates to initial credentialing, re-credentialing. Tracking of issues associated with activities necessary to maintain and document outgoing compliance with CPC policy and procedures. As requested, will be expected to research and resolve complex situations and assist with other tasks/projects.

What you will do in this role:

• Subject Matter Expert on policies, procedures and systems associated with position.
• Process Provider Action Forms(PAFs), Request for Consideration(RCFs) and Reappointment Requests for Consideration(RRFCs) and determine whether provider is already in Cactus system.
• Create/compile RFC/RRFC packets in Cactus.
• Track all RCF and RRFC packets and correspondence and maintaining documentation as requested.
• Manual data entry of information into Cactus system for credentialing and re-credentialing processes and data/image maintenance processes.
• Accurately perform a variety of administrative duties such as: data/image review, verifying data, placing calls, processing incoming data/images, processing facsimile verifications, scanning, sending written inquiries, filing, copying and other duties as needed.
• Review RFC and RRFC packets for completeness of information and identify missing information.
• Identify Incomplete and Unable to Key CVIs and pursue incomplete information and documents.
• Create new CVIs as applicable and notification and confirmation with MSO to confirm processing timeframe.
• Assure correct verifications are obtained based on specific provider's data and CPC policy and procedures, including but not limited to: state license(s), Federal and State DEA(s), board certification, education and peer references.
• Prepare, scan, attach, send correspondence, and receive correspondence of credentialing and re-credentialing data and images within RCF and RRFC documents for process review.
• HCO Delegate process to include changing assigned delegate, keying delegate information and updating Cactus required fields.
• Receive/Accept HCO applications and upload supporting documents.
• Accurately utilize Document Management Outbound to send verification letters.
• Perform on-line verifications to include submitting and retrieving Background Checks, AHP Board Certifications, AMA, iResponse, Sanction Check, NTIS, CDS/CSR and License verifications. Identification of Actions for RRFC providers; compare actions against existing Flags in Cactus to determine if red flag elevation is required.
• Perform Sent Not Received process including the Failure to Comply timelines and elevation to Compliance and Dynamic Credentials per CPC policies.
• Assure confidentiality of data.
• Ensure that all provider data/images are current and complete pursuant to expiration date per CPC policy and procedures.
• Document questionable information received and any issues identified during processing in Research Needed fields. Detailed information regarding follow-up attempts documents in the Contact Log.
• Compliance with all policy and procedure, Federal and State regulatory and accreditation agencies as required.
• Practice and adhere to the "Code of Conduct" philosophy and "Mission and Value Statement".
• Perform other duties and works on special projects as requested.

Qualifications:

• High School Graduate or GED. Associate degree or an equivalent combination of education and experience preferred.
• Minimum 1 year experience within Parallon credentialing Processing Center required.
• Completion of credentialing knowledge assessment and post Cactus training testing of 90% or greater.
• Professional telephone etiquette.
• Able to work with minimal supervision and works well in both individual and group environment.
• Successful completion of Credentialing 100, 101 and portions of 201 as it relates to verifier duties at the Parallon Credentialing Processing Center.

Benefits

• Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services
• Wellbeing support, including free counseling and referral services
• Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence
• Savings and retirement resources, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling
• Education support through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing
• Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts

Learn More About Employee Benefits

Note: Eligibility for benefits may vary by location.

Parallon

Parallon provides full-service revenue cycle management, or total patient account resolution, for HCA Healthcare. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing. We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Parallon has over 17,000 colleagues, and serves close to 1,000 hospitals and 3,000 physician practices, all making an impact on patients, providers and their communities.

HCA Healthcare has been recognized as one of the World's Most Ethical Companies by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

"Good people beget good people."- Dr. Thomas Frist, Sr.

We are a family 270,000 dedicated professionals! Our Talent Acquisition team is reviewing applications for our Credentialing Verifier II opening. Qualified candidates will be contacted for interviews.

We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.