Credentialing Verifier II: Compliance & Data Integrity

HCA Healthcare; Houston (TX); On-site; USD 42,000 - 64,000; Full time

Benefits offered by this job

Comprehensive benefits

Tuition assistance

Wellbeing support

Paid time off

401(k) match

Employee stock purchase plan

Education support

Job summary

Parallon, part of HCA Healthcare, is hiring a Credentialing Verifier II to manage credentialing and re-credentialing activities. The role involves handling RFC/RRFC packets, researching complex cases, and ensuring CPC policy compliance.

You will also perform online verifications and maintain meticulous documentation. Candidates should have at least a high school diploma, prefer an associate degree, and possess strong data entry and communication skills.

Qualifications

• High School graduate or GED; Associate degree preferred.
• Minimum 1 year experience within Parallon credentialing Processing Center required.
• Credentialing knowledge assessment completion with 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.

Responsibilities

• Subject Matter Expert on policies, procedures and systems associated with position.
• Process Provider Action Forms, Request for Consideration and Reappointment Requests 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 and communications.
• Review RFC and RRFC packets for completeness and identify missing information.
• Identify Incomplete and Unable to Key CVIs and pursue incomplete information and documents.
• Create new CVIs and notification with MSO to confirm processing timeframe.
• Assure correct verifications are obtained based on provider data and CPC policy and procedures (state licenses, DEA, boards, education, references).
• Prepare, scan, attach, send correspondence, and receive correspondence of credentialing data and images within RFC/RRFC documents for process review.
• HCO Delegate process to update delegate information in Cactus fields.
• Receive/Accept HCO applications and upload supporting documents.
• Utilize Document Management Outbound to send verification letters.
• Perform online verifications (Background Checks, Board Certifications, AMA, iResponse, Sanctions, NTIS, CDS/CSR, Licenses).
• Perform Sent Not Received process including Failure to Comply timelines and CPC policy-based elevations.
• Assure confidentiality of data.
• Ensure that provider data/images are current per expiration dates.
• Document questionable information and follow-up attempts in the Contacts Log.
• Comply with all policy, regulatory and accreditation requirements.
• Adhere to Code of Conduct and Mission/Value statements.
• Perform other duties and special projects as requested.

Skills

Professional telephone etiquette

Education

High School Graduate or GED

Associate degree

Tools

Cactus system

Job description

Parallon, part of HCA Healthcare, is hiring a Credentialing Verifier II to manage credentialing and re-credentialing activities. The role involves handling RFC/RRFC packets, researching complex cases, and ensuring CPC policy compliance.

You will also perform online verifications and maintain meticulous documentation. Candidates should have at least a high school diploma, prefer an associate degree, and possess strong data entry and communication skills.