The Credentialing Specialist is responsible for the data integrity of CorVel's provider credentialing database and contributes to the best possible patient experience by helping to ensure that providers in the CorVel network meet all established federal and state standards as well as National Committee for Quality Assurance (NCQA) standards. This position is remote, but training in our Richmond, VA office is required.
CorVel is a national provider of industry-leading risk management solutions for the workers' compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 3,500 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).
A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:
- Primary Source Verification – Obtain verification of license, education, certification, accreditation and other elements provided on facility and practitioner credentialing application.
- Alert Triage and Handling - Manage alert queue for incoming work. Including: provider record creation, application download and credentialing complete notification.
- Correspond with provider and PPO staff for missing items required for file completion and follow up on a regular basis.
- File preparation – Review of NPDB, malpractice history, sanctions. Summarize any issues to be presented to the committee. Copying issue file to committee folder.
- Location updates – Updating the credentialing database with demographic updates including location updates and terminations.
- Merges – Handling duplicate entries caused by the database with demographic updates including location updates and terminations.
- Research/standards – Investigating new sites for primary source verification. Keeping up to date with credentialing standards, credentialing program, and standard operating procedures.
- Requires regular and consistent attendance.
- Complies with all safety rules and regulations during working hours in conjunction with the Injury and Illness Prevention Program (“IIPP”).
- Additional projects and duties as assigned.
KNOWLEDGE & SKILLS:
- Excellent written and verbal communication skills.
- Ability to learn rapidly to develop knowledge and understanding of federal and state standards as well as the credentialing practice.
- Ability to identify, analyze and solve problems.
- Computer proficiency and technical aptitude with the ability to utilize MS Office including Excel spreadsheets.
- Strong interpersonal, time management and organizational skills.
- Ability to work both independently and within a team environment.
- Bachelor's degree or a combination of education and equivalent relevant experience.
- Minimum 1 year experience in credentialing.