Credentialing and CVO

Summary

Join our team as a Credentialing and Credential Verification (CVO) professional and contribute to a dynamic healthcare environment. This role offers significant learning and growth opportunities, working with top global talent. You will manage end-to-end licensing, credentialing, and privileging processes, ensuring compliance with industry standards. Daily responsibilities include provider data management, file review, and primary source verification. You will also analyze payer markets, develop reports, respond to provider inquiries, and mentor team members. This position requires strong communication, organizational, and project management skills, along with in-depth knowledge of credentialing processes and regulatory requirements. The ideal candidate will have a Bachelor's degree in a related field and 2-5 years of experience in credentialing.

Requirements

• Bachelor's degree in healthcare administration, Business, or a related field; master's degree preferred
• 2 - 5 years of experience in credentialing, with substantial experience
• In-depth knowledge of credentialing processes, privileging, and regulatory requirements
• Strong organizational and project management skills
• Excellent communication skills
• Skilled in preparing and delivering presentations to C Suite stakeholders

Responsibilities

• End to end Licensing/ CVO, Credentialing and Privilege processes to ensure compliance with industry standards and regulations
• Process physician accreditation, managed care, governmental and commercial insurance enrollment and re-credentialing
• Daily provider data management and review of credentialing files for accuracy and completeness, utilizing internal and external sources
• Analyze local payor IPA markets for partnerships or payer contracting opportunities
• Perform primary source verification via various state and national sources
• Oversees, updates and maintains provider credential database including CAQH, PECOS, NPPES Registry, Sharepoint any other applicable regulatory agencies
• Develops and prepares analytical reports monthly/quarterly of the summary of credentialing activity
• Responds timely to provider inquiries by letter, phone or internal communication
• Work closely and maintain relationships with provider relations at each payer, and communicates any challenges and/or concerns with manager timely
• Mentor and coach the team to provide highest levels of service and efficiency
• Maintain relationships with key Payers to facilitate negotiation of contracts
• Collaborate with internal departments to streamline and optimize credentialing operations
• Manage client relationships and provide high customer satisfaction
• Develop and implement policies and procedures to maintain the highest standards of credentialing excellence in the internal teams
• Stay informed about changes in accreditation and certification requirements and update processes accordingly
• Provide thought leadership via adoption of best practices based on industry changes and technology adoption

Preferred Qualifications

Established relationship with key payers will be a plus