Verification Examiner




Remote Worker Considerations


Candidates who are selected for this position will be trained remotely and must be able to work from home (WFH) in a designated work area with company-provided technology equipment. This remote/WFH position requires you have a stable connection to your Internet Service Provider with the ability to participate by video in online meetings over a reliable and consistent network (minimum internet download of 50 Mbps and 10 Mbps upload speed).


Responsibilities

  • Performs verification and updates PROMIS according to standards and health plan expectations.
  • Verifies with the appropriate agencies that the applicant has a current and valid license.
  • Checks with the appropriate agencies to determine whether the applicant has had any sanctions against his/her license.
  • Determines whether the applicant has had any Medicare or Medicaid sanctions using the latest Cumulative Sanctions Report released by the Department of Health and Human Services.
  • Obtains verification of current Professional Liability Insurance and malpractice claim history for each applicant.
  • Verifies education through State licensing agencies or appropriate schools, colleges, or universities.
  • Communicates with practitioners by mail, fax, or phone to answer questions and obtain information.
  • Verifies whether an applicant has full or limited/partial clinical privileges by contacting the facility.
  • Maintains confidentiality of all practitioner data, and related issues.
  • Completes assigned work within predetermined timelines.
  • Enters data in PROMIS to complete each portion of the credentialing process within predetermined timelines.
  • Provides teamwork and assistance to all department staff, including participating in special projects and related credentialing assignments.

Qualifications

  • High School diploma required.
  • Industry experience preferred.
  • One year computer experience including word processing and spreadsheet applications.
  • Proficient in MS Office.

Core Competencies

  • Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships.
  • Ability to display excellent customer service to meet the needs and expectations of both internal and external customers.
  • Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment.
  • Ability to effectively organize, prioritize, multi-task and manage time.
  • Demonstrated accuracy and productivity in a changing environment with constant interruptions.
  • Demonstrated ability to analyze information, problems, issues, situations and procedures to develop effective solutions.
  • Ability to exercise strict confidentiality in all matters.

$15/hour


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