Credential Verification Provider Navigator

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Summary:

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Responsibilities:

• On-boarding coordination for newly hired providers, utilizing and updating internal systems for tracking and reporting progress.
• Review of credentialing applications to determine completeness, and conduct primary source verification of the provider information, following appropriate internal credentialing requirements
• Facilitates the timely and accurate completion of all provider applications within time limits - including but not limited to acquisition of New Mexico Medical License, Controlled Substance Registration (CDS) and Drug Enforcement Agency number (DEA), hospital credentialing, payor enrollment
• Identifies issues during the process and conducts appropriate investigation to resolve these issues
• Obtains the required information for Provider Enrollment and provides it in a timely manner.
• Facilitates the request to establish the providers certificate of insurance (COI)
• Serves as a resource to the providers as well as to other departments (e.g., human resources, recruitment, provider enrollment, administrative leaders, etc.
• Maintains a flexible schedule to allow for evening/weekend capability in order to meet the providers schedule
• Understands and maintains current knowledge of state and federal regulatory requirements and accreditation standards as they apply to all aspects of credentialing
• Utilize the credentialing database for the credentialing process, as well as maintaining relevant data.
• Regularly communicates with the following departments and individuals: Recruitment, Human Resources,Medical Staff Affairs, Provider Enrollment, Director of Practice Operations/Manager of Practice Operations and Medical Directors.Provide updates on the status of providersA onboarding process. Determines when issues require escalation to these departments as well as directors of provider operations and medical directors.
• Ensures that all records (electronic and/or paper) are stored in a secure location and that no confidential information is readily available when away from the office/desk
• Maintains a tickler system for follow-up on incomplete applications or unanswered correspondence in order to meet established turnaround times and maintain departmental and the CVO clientAs standards
• Employs public relations skills in a wide variety of phone contacts and written communications with external sources for purposes of soliciting information essential to credentials verifications, including licensing agencies, university and hospital training program administrators, certification boards, liability insurance carriers, hospital officials and credentials staff, physicians and their office staff.
• Shares responsibility for developing and maintaining an environment that supports service excellence.
• Exercises discretion and independent judgment involving the comparison and the evaluation of possible courses of action related to meeting primary source verification and credentialing requirements. Acts or reaches decisions independently after the various possibilities have been considered.

Qualifications:

• High School Diploma or GED
• Two-three years college or Associates Degree with one- three years of experience in medical staff services, physician practices, customer service or other related field.
• One to three years experience in hospital medical staff or managed care credentialing preferred. Equivalent relative experience in the industry will be considered in lieu of a degree.
• Excellent written and oral communication skills.
• Project Management skills.
• Understanding of the New Mexico medical licensing requirements.
• Proficient in MS Office Suite, particularly Word and Excel.

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.

Wellness
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.

About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.