Credentialing

BASIC PURPOSE:

 Responsible for processing internal applications for membership with our staffing company. This role ensures that all applications meet company standards and underwriting requirements.

ESSENTIAL FUNCTIONS:

• Coordinate verification and risk assessment processes using NCQA, the Joint Commission, and other appropriate standards as outlined in company policies.
• Process clinical candidate applications, including underwriting facilitation.
• Evaluate completed provider applications by systematically comparing applicant-reported data with primary source verifications and internal credentialing standards.
• Identify and investigate discrepancies, document findings, and coordinate with appropriate parties to resolve issues before Risk Review.
• Credentials verifications on initial applications and reapplications of clinical candidates, including extended verifications as needed by internal and/or external clients.
• Assessment of risk for clinical candidates to underwrite them for malpractice insurance.
• Data entry and data integrity of the provider within the credentialing system and company database.
• Liaison to providers as point person for completion and delivery of required information promptly.
• Assist in the ongoing documentation of internal credentialing processes while seeking out opportunities to improve these procedures.
• Other duties as assigned.
•  Must have the ability to perform the essential functions of the job with or without reasonable accommodation.

REPORTING RELATIONSHIPS:

• This position does not have any direct reports.

QUALIFICATIONS: 

• Minimum of 1 year of experience in healthcare credentialing, medical staff services, or a related field.
• Experience with provider credentialing, underwriting, or healthcare staffing credentialing is preferred.
• Preferred: Certified Provider Credentialing Specialist (CPCS) certification or ability to obtain this certification within the first 2 years in the role.
• Proficiency in credentialing software and Microsoft Office Suite.
• Obtain comprehensive knowledge of credentialing standards, procedures, and regulatory requirements.
• Exceptional attention to detail and accuracy.
• Strong analytical and problem-solving skills.
• Excellent interpersonal and communication skills via phone, email, and person-to-person.

CRITICAL COMPETENCIES FOR SUCCESS:

•  Business Acumen: In-depth knowledge of the business, industry, and external marketplace, and the ability to conceptually pull together patterns or connections that are not clearly related; ability to apply insight across a wide range of tactical to strategic issues to consistently identify and select the best course of action.
• Cognitive: Assesses situations and analyzes problems; generates alternative solutions; takes appropriate actions. Uses good judgment and makes sound decisions, has strong analytical ability, and planning skills; ability to learn new systems and processes.
• Communication: Maintains clear, timely, accurate, and professional communication with team and business partners. Excellent verbal, written, and presentation skills. Excellent interpersonal and active listening skills to ensure understanding.
• Disciplined Execution: Orientation towards a process-focused, decisive course of action that will ensure client/customer needs are met with a high standard of excellence, urgency, and predictability; focused on the task at hand and applies past experiences and expertise to consistently pull through results.
• Independent/Teamwork: Ability to work independently; self-motivated to meet/exceed goals. Have a strong commitment to being a team player. Work collaboratively with people from all levels and parts of the organization; build and sustain positive business relationships with customers, clients, and co-workers. Ability to work in a harmonious, respectful, supportive manner with all internal & external clients.
• Job/Technical Knowledge: Demonstrates knowledge of technical systems, procedures, and processes for successful performance; keeps abreast of and responds to changes in industry, market, and job field.
• Organizational Collaboration: Ability to partner across organizational lines and work cooperatively within and outside one’s team to best serve client needs and exceed the expectations of end customers and clients; actively supports key decisions and promotes a spirit of teamwork to demonstrate commitment to the company.
• Responsibility/Individual Effectiveness: Assertive character; takes ownership; assumes responsibility of work output and performance; exhibits flexibility in responding to job demands and change; willingly takes on new responsibilities; maintains composure in highly stressful situations; proactive; organized, utilizes time effectively. Prioritizes to meet timeliness and commitments; generates new ideas; makes constructive suggestions/accepts constructive feedback, and openly engages in dialog around improvement opportunities. Demonstrates Cross Country corporate values.
• Strategic Agility: Eagerness and ability to learn quickly and leverage a flexible mindset in response to shifting dynamics, adversity, and/or change; continually pushes oneself, their teams, and their businesses to learn, to generate new ideas, and (at times) to take needed risks to position the company favorably in the marketplace.

WORK CONDITIONS:

·         Open work area. General fast-paced office environment.

·         Travel up to 10% of the time, or as requested.

·         Employees must possess comfort in learning, training, and engaging with others virtually through Microsoft Teams and Zoom.