QUALIFICATIONS
- Must possess 2+ years of post-high school education, training, experience.
- Must possess 3+ years of work experience in the health care environment and general
knowledge of the health care industry including hospital settings, physician practices, and
managed care organizations - Must possess knowledge of Provider, Delegated and Facility credentialing for Health Plan(s).
- Knowledge and understanding of NCQA, Joint Commission, NPDB guidelines, hospital policies
and procedures, and general licensing regulations. - Knowledge of CAQH database in its entirety
- Knowledge and experience with database organization and management, report generating
languages, PC's and proficiency in Windows & Google-based word processing software - Strong communication skills including the ability to correspond effectively, as well as verbally
convey information clearly, listen actively, and consider varying viewpoints when making
decisions - Strong statistical, analytical and problem-solving skills
- Ability and desire to provide quality service to others
- Strong organizational skills and the ability to provide attention to detail and thoroughness
- Ability to work autonomously and within a team environment
- Must possess the ability to comply with Curative Credentialing policies and procedures
DUTIES & RESPONSIBILITIES
- Maintains confidentiality of all business matters at all times
- Facilitates timely processing of Initial and Recredentialing process for new applicants and
existing participating providers. - Collects, reviews documentation and ensures timely and accurate credentialing and
recredentialing application submissions for each provider as it relates to each payer contract. - Produces correspondence as necessary to process applications
- Conduct, as needed, Primary Source Verification of credentials and processes the information to
determine suitability for Curative’s network participation. - Accurately enters credentialing information into appropriate database. Run reports as needed
on credentialing status of in process applications. - Monitor expireables and communicating with Providers on a consistent and regular cadence as
outlined in Curative’s Credentialing Policies and Procedures - Performs other duties, as assigned.
- Knows, understands, incorporates, and demonstrates the Curative Mission, Vision, and Values in
behaviors, practices, and decisions - Assists in the training and orientation of new team members
- Assists in daily data entry to ensure an accurate physician data base
- Communicates regularly with applicants to complete all requirements of the credentialing criteria within specified timeframes.
- Meets processing time thresholds consistently and with minimal error.
- Maintains a customer-focused attitude, good rapport, and cooperative relationships.
- Approaches conflict in a constructive manner
- Helps to identify problems, offer solutions, and participate in their resolution.
- Tracks errors and complaints to assist with process improvement activities.
- Participates in professional development programs and professional organizations to grow an understanding of the various regulations and legislation of the health care industry as appropriate.
- Maintains a working knowledge of applicable Federal, State and local laws/regulations; the Curative Integrity and Compliance Program and Code of Conduct; as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior.
PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS
- Must be able to set and organize own work priorities and adapt to them as they change
frequently - Must be able to work concurrently on a variety of tasks/projects in an environment that may be
stressful with individuals having diverse personalities and work styles - Ability to complete work during high-pressure periods while maintaining flexibility and a
pleasant attitude