认证专员
Credentialing Specialist
职位描述
Credentialing Specialist 负责为 IVX Health 所运营的所有州和司法管辖区的从业者进行资质认证和注册。Credentialing Specialist 负责准备、跟踪并提交执照、认证和资质申请至各类政府机构和商业保险公司办公室。Credentialing Specialist 负责通过成功完成商业保险公司、Medicare 和 Medicaid 要求的初始和后续资质包，确保所有提供者保持有效状态。
职责
- 维护每位提供者的文件，包括完成所需政府和商业保险公司资质申请所需的最新信息
- 为新提供者进行资质认证，并对持有工作人员特权的诊所中的现有提供者进行重新资质认证
- 负责促进所有保险公司从业者链接申请的完成
- 管理并维护所有当前提供者的合同、执照和资质
- 定期与保险公司沟通，包括但不限于接收季度费用表、更新和其他相关文件
- 制定、实施并监控流程和程序，以确保高效且经济地一致交付高质量的合同和资质服务
- 确保资质项目符合健康计划以及州和联邦法规，包括 Medicare、Joint Commission、IMQ、AAAHC 和其他认证机构的要求
- 跟踪每个所需组织、机构、附属机构和第三方保险公司的注册状态
- 在 CAQH、PECOS 和 CMS 数据库中维护准确的提供者档案
- 维护所有活跃提供者文件的数据库，包括 Verity 和 Availity
- 为新提供者进行资质认证，并对持有工作人员特权的诊所中的现有提供者进行重新资质认证
核心能力
- 出色的书面和口头沟通能力，具备与各种外部和内部利益相关者有效互动的实际能力
- 强大的分析和解决问题的能力
- 能够识别并解决模糊或冲突的目标
- 了解提供者资质及其对实践收入周期的直接影响
- 熟练使用标准办公软件应用（Microsoft Office、Outlook、Teams 等）
教育背景与经验要求
- 本科学历或同等学历
查看英文原文
ABOUT THE ROLE
The Credentialing Specialist is responsible for credentialing, enrollment of practitioners reporting for all states and jurisdictions in IVX Health operates. The Credentialing Specialist prepares, tracks, and submits licensure, certification and credentialing applications to various government and commercial payor offices. The Credentialing Specialist is responsible for maintaining active status for all providers by successfully completing initial and subsequent credentialing packages as required by commercial payers, Medicare, and Medicaid.
RESPONSIBILITIES
- Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications
- Credential new providers and re-credential current providers with clinics at which they hold staff privileges
- Responsible for facilitating the completion of all payer practitioner linking applications
- Manage and maintain contracts, licenses and credentials for all current providers
- Perform regular communication with payers including but not limited to receiving quarterly fee schedules, updates, and any additional relevant documentation
- Develop, implement, and monitor processes and procedures to ensure the consistent delivery of quality contracting and credentialing services in an efficient and cost-effective manner
- Ensure that the credentialing program is compliant with health plans, as well as State and Federal regulations including Medicare, Joint Commission, IMQ, AAAHC and other accrediting bodies
- Track enrollment status with each required organization, agency, affiliate, and third-party payer
- Maintain accurate provider profiles on CAQH, PECOS, and CMS databases
- Maintain databases for all active provider files to include Verity and Availity
- Credential new providers and re-credential current providers with clinics at which they hold staff privileges
ESSENTIAL COMPETENCIES
- Exceptional written and verbal communication skills, with a proven ability to interact effectively with a variety of external and internal constituents
- Strong analytical and problem-solving skills
- Ability to recognize and resolve ambiguous or conflicting objectives
- Knowledge of provider credentialing and its direct impact on the practices revenue cycle
- Proficiency with standard office software applications (Microsoft Office, Outlook, Teams, etc.)
REQUIRED EDUCATION & EXPERIENCE
- Bachelors degree or equivalent work experience
- 3-5 years experience and demonstrated success in provider and facility contracting and credentialing with commercial and government payers
- Certified Provider Credentialing Specialist (CPCS) certification preferred
- Demonstrated experience in working with multi-site and/or multi-state providers
- Experience with Infusion, G/I, Rheum, Neuro and/or large distributed medical practices desired
Pay is based on factors such as market location, job-related knowledge, skills, and experience, and is benchmarked against similar organizations in our size and industry. It is not typical for an individual to be hired at or near the top of the posted range, as compensation decisions depend on the facts and circumstances of each case. In addition to cash pay, full-time regular employees are eligible for 401(k), health benefits, and other company-provided benefits.
Credentialing Specialist Pay Range
$20—$26 USD
About IVX Health
IVX Health is a national provider of infusion and injection therapy for patients managing complex chronic conditions. Through a patient-centered approach focused on comfort, convenience, clinical excellence, and exceptional service, we're redefining the care experience and improving lives every day. As a growing healthcare organization, we're committed to supporting our employees with meaningful work, professional development opportunities, and a culture built on collaboration, innovation, and purpose.
Guided by Our Purpose
Mission: To improve the lives of those we care for by redefining the care experience.
Vision: To be the nation's preferred destination for pharmaceutical care of complex chronic conditions.
Values: Be Kind. Do What's Right. Never Settle. Make It Happen. Enjoy the Ride.
Benefits & Perks
Eligible employees may receive:
- Medical, Dental, and Vision Coverage
- Prescription Drug Coverage and Telemedicine Services
- Health Savings Account (HSA), Health Reimbursement Arrangement (HRA), and Flexible Spending Options
- 401(k) Retirement Plan with Company Match
- Life, AD&D, and Disability Insurance
- Accident, Critical Illness, and Hospital Indemnity Coverage
- Fertility and Family Planning Support
- Tuition Reimbursement and Certification Assistance
- Continuing Education and Professional Development Resources
- Employee Assistance Program and Wellness Support
- Paid Time Off
- Volunteer Time Off and Charitable Giving Match
- Employee Referral Bonus Program
Benefits may vary based on employment status and eligibility.
EEO STATEMENT
IVX Health is proud to be an Equal Opportunity Employer. We are committed to creating an inclusive workplace where all employees are treated with respect and provided equal employment opportunities. Employment decisions are made based on business needs, job requirements, qualifications, merit, and applicable law.
IVX Health prohibits discrimination, harassment, and retaliation of any kind and is committed to providing reasonable accommodations to qualified individuals with disabilities and those with sincerely held religious beliefs.
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Originally posted on Himalayas