Qualifications

• Must possess 2 years of post-high school education, training, or 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 Delegated, Facility and Managed Care credentialing.
• Knowledge and understanding of NCQA and TJC standards, 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-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

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 Ensures the timely completion of an application for initial and/or re-credentialing by assisting the applicant in submitting all documentation necessary to process the application. Performs a variety of credentialing tasks at the direction of the Sr. Credentialing Manager and other management to complete the credentialing process for Curative. This position is an integral part of the credentialing team and is responsible for following credentialing policies and procedures; maintaining an accurate physician data base; collecting data; and participating in development and implementation of changes to the credentialing processes.
• Knows, understands, incorporates, and demonstrates the Curative Mission, Vision, and Values in behaviors, practices, and decisions Assists the Sr. Credentialing Manager in the identification and scheduling of reappointment candidates. Performs file audits and provides feedback on completed initial and reappointment credentialing files. •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. Contacts various primary sources to gather the required verifications to complete the background investigation via telephone, fax transmissions, mailings and Internet to ensure rapid completion of the application. Prepares documentation of all verifications including a summary of all verified references for each completed credentials file
• Assists in the reappointment process; collecting required information, verifying information, and completing appropriate follow-up to complete the reappointment application
• 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 in understanding of the various regulations and legislation of the health care industry as appropriate.
• Performs other duties as needed and assigned by the Sr. Credentialing Manager and or Director of Provider Development
• 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.