**Remote opportunity available for the right candidate!
The CVO Credentialing Specialist is responsible for credentialing and re-credentialing providers within the Northern Light Health System. Credentialing functions include, but are not limited to, processing credentialing/re-credentialing applications, performing primary source verification and updating and maintaining the credentialing database in accordance with internal policies and procedures and applicable Federal and State regulatory standards. Effectively builds positive, quality-enhancing relationships between the Medical Staff Services Department and the Centralized Credentialing and Verification Office (CPDM).
• Perform medical credentialing file/element investigation and primary source verification of provider’s initial and re-credentialing applications, utilizing established Standards, Client specifications and federal and state regulatory requirements. Ensure timely compilation of applicant and verification elements to prevent any negative outcomes or delays in the processing of applications/files.
• Uniformly apply clearly defined credentialing processes to all practitioners/providers.
• Maintain timely communication with applicants and member organizations on the status of the application files and any required documents or information needed to complete the medical credentialing process.
• Effectively conduct thorough investigation and compilation of the provider/applicant’s medical credentialing applications to assure compliance with System requirements and standards.
• Obtains and evaluates practitioner sanctions, complaints and adverse data to ensure compliance and alerts Manager of any undisclosed negative findings immediately.
• Analyze and maintains provider data entered in the ECHO database to ensure accuracy for Client Rosters, Third Party Portal, National Practitioner Data Bank and Provider Finder.
• Independently organizes information and data to identify/explain trends, problems, and their causes. Compares, contrasts, and combines information to determine underlying issues. Sees associations between seemingly independent problems or events to recognize trends, problems, and possible cause-effect relationships.
• Identify administrative and professional issues with applications that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up with applicant, and Clients.
• Participate and support with suggestions for the development and improvement of workflow, client support and compliance goals to advance the quality of practitioners and patient safety to the System.
• Maintain knowledge of current regulatory requirements for medical credentialing.
• Performs miscellaneous job-related duties as assigned.
Competencies and skills: Essential: * Behaves with Integrity and Builds Trust: Acts consistently in line with the core values, commitments and rules of conduct. Leads by example and tells the truth. Does what they say they will, when and how they say they will, or communicates an alternate plan. * Cultivates Respect: Treats others fairly, embraces and values differences, and contributes to a culture of diversity, inclusion, empowerment and cooperation. * Fosters Accountability: Creates and participates in a work environment where people hold themselves and others accountable for processes, results and behaviors. Takes appropriate ownership not only of successes but also mistakes and works to correct them in a timely manner. Demonstrates understanding that we all work as a team and the quality and timeliness of work impacts everyone involved. * Practices Compassion: Exhibits genuine care for people and is available and ready to help; displays a deep awareness of and strong willingness to relieve the suffering of others.
Education: Essential: * Associate's Degree
Pursuing NAMSS Certification as a Certified Provider Credentials Specialist (CPCS) or Certified Professional Medical Services Manager (CPMSM) required.
Professional Association: Affiliation and participation with the National Association Medical Staff Services and the Maine Association Medical Staff Services is strongly encouraged.
Regulatory Requirements: Working knowledge of the medical staff organization and Joint Commission/Healthcare Facilities Accreditation Program/National Committee for Quality Assurance standards. State/federal/licensure regulations, particularly as it relates to the credentialing of physicians and advanced practice professionals.
Working conditions: Essential: * Need to drive to perform responsible duties. * Work with computers, typing, reading or writing. * Work beyond the regularly scheduled hours. * Extend body and limbs to reach items. * Lifting, moving and loading less than 20 pounds. * Continuous sitting. * Alternate shift schedules (day, evening, nights, weekends). * Continuous walking.
Equal Opportunity Employment
We are an equal opportunity, affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, disability status, gender, sexual orientation, ancestry, protected veteran status, national origin, genetic information or any other legally protected status
* Associate's Degree
Internal Number: 5515
About Northern Light Health
Northern Light Health exists to make healthcare work for you. That is our mission. That is our purpose. Northern Light Health is the most expansive integrated health care system in Maine. We provide care to people from Portland to Presque Isle and from Blue Hill to Greenville. We are comprised of ten member hospitals with 584 long-term beds, a single physician-led medical group, eight nursing homes, five emergency transport members, 37 primary care locations, and we employ more than 12,000 people in Maine.
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National Association Medical Staff Services
2001 K Street NW, 3rd Floor North | Washington, DC 20006
Phone: 202-367-1196 | Fax: 202-367-2196 | E-mail: firstname.lastname@example.org