Credentialing Specialist

Credentialing Specialist
Credentialing Specialist
Who are we?
Versant Health is one of the nation's leading administrators of managed vision care, serving millions of our clients' members nationwide. We are driven by our mission to help members enjoy the wonders of sight through healthy eyes and vision.
As a Versant Health associate, you can enjoy a comprehensive Total Rewards package, which includes health and dental insurance, tuition reimbursement, 401(k) with company match, pet insurance, no-cost-to-you vision insurance for you and your qualified dependents. We are also invested in your success. There are many opportunities for advancement and development throughout all stages of your career with us.
See how you can make a difference with the support of strong leadership and a team environment.
See Everything, Be Anything™.
What are we looking for?
The Credentialing Specialist role is responsible for educating, verifying, and monitoring all Ophthalmology and Optometric practitioners, to ensure every provider, who provides service to Versant Health members, possess and maintains complete Credentialing and Re-credentialing documentation and compliance with National Committee for Quality Assurance (NCQA) standards.
Where you will have an impact

• Educate physicians, administrators, and office personnel on:
• The Council for Affordable Quality Healthcare (CAQH) credentialing application, documentation, and compliance standards
• Initial Credentialing compliance and documentation, application processing, and event timing
• Initial Credentialing compliance and documentation, application processing, and event timing
• Have direct interaction with physicians, providers, administrators, and their office personnel on the timing of Provisional Credentialing, Initial Credentialing and Recredentialing events
• Ensure compliance with all individual states, the National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC), and Versant Health regulations and standards when processing initial credentialing and re-credentialing applications and documentation submitted to Versant Health
• Proficiency and expertise knowledge in performing primary source credentialing and sanction queries:
• The National Practitioner Databank (NPDB)
• Medical Licensing Board queries in all 50 states, Puerto Rico, and Guam
• American Board of Medical Specialties (ABMS)
• Educational Commission for Foreign Medical Graduates (ECFMG)
• Schools of Optometry
• Hospital privileges
• Office of Foreign Assets (OFAC)
• Office of Inspector General (OIG)
• System for Award Management (SAM)
• Has performed and processed Provisional Credentialing events, to support a Sales driven culture
• Supports the Primary Source Verification (PSV) functions with Versant Health's Credentialing Verification Organization (CVO), to include production, daily operations, and quality
• Participates in the Credentialing Committee meetings as needed; prepare minutes of the Credentialing Committee meetings
• Ensures compliance of all physician and provider credentialing data entered into Versant Health's provider databases
• Create and maintain provider credentialing and recredentialing files in compliance with all Versant Health policies, production and quality standards
• Prepare all documentation required for presentation to various Versant Health committees as requested

What's necessary to do the job?

• High School Diploma or GED required; some Collegeor University education preferred
• Minimum of Four (4) years experience in provider credentialing, preferably in a managed care setting
• Knowledge of National Committee for Quality Assurance (NCQA) Credentialing and Recredentialing standards
• Experience must include direct responsibility for processing medical and professional credentialing, recredentialing, and delegated credentialing
• Knowledge and experience in the insurance, health, or vision care industry required
• Proficient in Microsoft Office, experience with Excel, working knowledge of Microsoft SharePoint, Outlook and Access applications preferred
• Certified Provider Credentialing Specialist (CPCS) preferred
• Able to work well under tight deadlines, responds well to rapidly changing demands, and provides efficient follow up with Educate physicians, administrators, and office personnel
• Capable and comfortable dealing with sensitive and confidential information with discretion and trust

HIPAA & Security Requirements
All Associates must comply with the Health Insurance Portability Accountability Act of 1996 (HIPAA) as it pertains to disclosures of protected health information (PHI) as described in the Notice of Privacy Practices and HIPAA Privacy Policies and Procedures. As a component of job roles and responsibilities, Associates may have access to covered information, cardholder data or other confidential customer information which must be protected at all times. As a result, Associates must explicitly adhere to all data security guidelines established within the Company's Privacy & Security Training Program.
Versant Health will never request money from candidates who seek employment with us and will never ask for any payment as part of the recruitment process.
Versant Health is a proud Equal Employment Opportunity and Affirmative Action employer dedicated to attracting, retaining, and developing a diverse and inclusive workforce. All qualified applicants will receive consideration for employment at Versant Health without regards to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, age, disability, national origin, marital or domestic/civil partnership status, genetic information, citizenship status, uniformed service member or veteran status, or any other characteristic protected by law.
The wage range for applicants for this position is [$20.00 to $21.50].
All incentives and benefits are subject to the applicable plan terms.
Other details

• Job Family Non Exempt
• Pay Type Hourly
• Employment Indicator BAU

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