Provider Onboarding Liaison - Credentialing Verification

Apply Now

918204

Vidant Health

Full Time

Regular

Summary

About Vidant Health

Vidant Health is a regional health system serving 29 counties in eastern North Carolina. We are working every day to improve the health of the 1.4 million people we serve. Vidant Health is made up of 8 hospitals, physician practices, home health, hospice, wellness centers and other health care services. Vidant Medical Center is affiliated with the Brody School of Medicine at East Carolina University. As a major resource for health services and education, Vidant Health strives to support local medical communities and to work with providers throughout the region to deliver quality care. Our goal is to enhance services that are available locally and to eliminate barriers involving time, distance and lack of awareness that sometimes prevent patients from receiving the care they need.

Responsibilities

  • Processes requests for enrollment of new VMG providers and/or practices:
  • Provides health plan enrollment services for all eligible providers for commercial and government payors. Provide follow up as needed to ensure providers are enrolled with the appropriate payors. Maintain and update provider enrollment information, including provider numbers and effective dates in the Cactus database.
  • File creation and storage for delegated credentialing and health plan enrollment. Maintains paper files for initial and recredentialing of delegated, non-delegated, and government payor files.
  • Relays understanding of regulatory standards in conjunction with Vidant Health Accreditation. Stay abreast of changing NCQA (managed care), Joint Commission (hospital), and CMS (regulatory) standards and adjust CVO practices to ensure compliance.
  • Provides guidance and problem resolution for contracted health plans to information systems, the Central Billing Office, practice managers, providers, VMG representatives and appropriate leadership.
  • Makes onsite visits to providers and/or practices to retrieve signatures, missing information, answer questions, etc.
  • Maintains correspondence with all parties regarding the onboarding process and updates as necessary.
  • Produces weekly reports for all VMG providers to identify provider names, practice locations, effective dates and status for distribution to designated personnel.
  • Creates and maintain website content for new providers to include frequently asked questions and what to expect.
  • Assists leadership in policy revisions, creation and revisions of standards of procedures, and quality improvement initiatives.
  • Coordinates with other CVO divisions in order to identify and maintained integration of data/information and streamlined processes.
  • Assists Supervisor and Manager as needed.

Minimum Requirements

  • High School + 2 plus yrs. of formal training/education is required.
  • CPCS certification preferred.
  • 1 - 3 years experience is required.
  • Proficiency with Microsoft Word, Excel and Access preferred.
  • Knowledge of NCQA (National Committee for Quality Assurance) guidelines, state regulations, and proficiency with Visual Cactus is preferred

Other Information

  • 1 full time vacancy, days.

General Statement

It is the goal of Vidant Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.

Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.

We value diversity and are proud to be an equal opportunity employer.   Decisions of employment are made based on business needs, job requirements and applicant’s qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.

 

Share This: