Credentialing Coordinator
Location:
Cumberland , Rhode Island
Posted:
November 24, 2017
Reference:
692282BR
Position Summary:
The Credentialing Coordinator is responsible for initial credentialing and re-credentialing nurse practitioners, physician assistants and physicians in a compliant and timely manner; ensure timely and accurate enrollment submissions and re credentialing applications for providers as it relates to payer contracts; monitor expirable credentials and compliance monitoring in accordance with Joint Commission accreditation, NCQA and URAC credentialing standards as required.

Key Responsibilities:

- Responsible for the timely and accurate processing of provider initial and Re-credentialing applications according to MinuteClinic Provider Credentialing Program
- Monitor Expirable licensure and maintain communication with providers in advance of expiration's to ensure renewal in a timely manner, escalating to team manager and field management as appropriate.
- Conduct sanctions and compliance monitoring and alert Credentialing Manager and Revenue Director of any undisclosed negative findings
- Ensure timely payer applications are submitted for each provider to mitigate financial impacts to the business
- Respond to all payer inquiries in a timely manner
- Assist in resolving payer claims issues in corporate billing system
- Make recommendations for process improvement and system efficiencies
- Model a positive attitude in interactions with team members


Required Qualifications:
- 2+ years experience in the healthcare industry
- 2+ years MS Office experience


Preferred Qualifications:
- 3+ years experience in the healthcare industry
- E
xperience in credentialing
- Demonstrated understanding of initial credentialing and re-credentialing practices for medical professionals including primary source verification methods, compliance monitoring and expireables management.
- Understanding of Joint Commission Accreditation, NCQA and URAC credentialing standards.
- Ability to function independently and utilize critical thinking skills to accomplish goals and objectives
- Effective communication skills; verbal and written
- Strong interpersonal skills including the ability to work well with internal and external stakeholders
- Strong organizational skills and the ability to multitask
- NAMSS Certified Professional Credentialing Specialist (CPCS) certification

Education:
Verifiable High School Diploma or GED is required. Bachelor’s degree in Business Administration, Healthcare Administration or related field preferred

Business Overview:
CVS Health, through our unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. We are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers. What are we looking for in our colleagues? We seek fresh ideas, new perspectives, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day. As the nation’s largest pharmacy health care provider, we offer a wide range of exciting and fulfilling career opportunities across our three business units – MinuteClinic, pharmacy benefit management (PBM) and retail pharmacy. Our energetic and service-oriented colleagues work hard every day to make a positive difference in the lives of our customers.

CVS Health is an equal opportunity employer. We do not discriminate in hiring or employment against any individual on the basis of race, ethnicity, ancestry, color, religion, sex/gender (including pregnancy), national origin, sexual orientation, gender identity or expression, physical or mental disability, medical condition, age, veteran status, military status, marital status, genetic information, citizenship status, unemployment status, political affiliation, or on any other basis or characteristic prohibited by applicable federal, state or local law. CVS Health will consider qualified job candidates with criminal histories in a manner consistent with federal, state and local laws. CVS Health will not discharge or in any other manner discriminate against any Colleague or applicant for employment because such Colleague or applicant has inquired about, discussed, or disclosed the compensation of the Colleague or applicant or another Colleague or applicant. Furthermore, we comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. If you require assistance to apply for this job, please contact us by clicking AA EEO CVS Health

For inquiries related to the application process or technical issues please contact the Kenexa Helpdesk at 1-855-338-5609. For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-987-5352. Please note that we only accept resumes via our corporate website: https://jobs.cvshealth.com/

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