Credentialing Verifier II Part Time

About the Role

As a Credentialing Verifier II with Parallon, you will be part of an organization devoted to giving back to communities, with colleagues who invested over 156,000 hours volunteering last year. This role involves credentialing collection and verification activities for initial credentialing, re-credentialing, and tracking compliance with CPC policies and procedures. You will research and resolve complex situations and assist with other tasks or projects as needed.

Responsibilities

• Serve as a Subject Matter Expert on policies, procedures, and systems associated with the position.
• Process Provider Action Forms (PAFs), Request for Consideration (RCFs), and Reappointment Requests for Consideration (RRFCs) to determine if the provider is already in the Cactus system.
• Create and compile RFC/RRFC packets in Cactus, track all packets and correspondence, and maintain documentation.
• Perform manual data entry into the Cactus system for credentialing, re-credentialing, and data/image maintenance processes.
• Accurately perform administrative duties such as data/image review, verifying data, placing calls, processing incoming data/images, fax verifications, scanning, sending written inquiries, filing, and copying.
• Review RFC and RRFC packets for completeness and identify missing information.
• Identify Incomplete and Unable to Key CVIs, pursue missing information and documents, and create new CVIs as applicable.
• Notify and confirm processing timeframes with MSO.
• Ensure correct verifications are obtained based on provider data and CPC policies, including state licenses, Federal and State DEAs, board certification, education, and peer references.
• Prepare, scan, attach, send, and receive correspondence for credentialing and re-credentialing data and images within RCF and RRFC documents.
• Manage HCO Delegate processes, including changing assigned delegates, keying delegate information, and updating required fields in Cactus.
• Receive and accept HCO applications and upload supporting documents.
• Utilize Document Management Outbound to send verification letters accurately.
• Perform online verifications, including submitting and retrieving Background Checks, AHP Board Certifications, AMA, iResponse, Sanction Check, NTIS, CDS/CSR, and License verifications.
• Identify Actions for RRFC providers and compare actions against existing Flags in Cactus to determine if red flag elevation is required.
• Perform Sent Not Received processes, including Failure to Comply timelines and elevation to Compliance and Dynamic Credentials per CPC policies.
• Maintain confidentiality of data and ensure all provider data/images are current and complete pursuant to expiration dates.
• Document questionable information and issues identified during processing in Research Needed fields and follow-up attempts in the Contact Log.
• Comply with all policies, procedures, Federal and State regulatory, and accreditation agency requirements.
• Adhere to the "Code of Conduct" philosophy and "Mission and Value Statement."
• Perform other duties and work on special projects as requested.

Requirements

• High School Graduate or GED.
• Associate degree or an equivalent combination of education and experience preferred.
• Minimum of 1 year of experience within the Parallon Credentialing Processing Center required.
• Completion of credentialing knowledge assessment and post-Cactus training testing with a score of 90% or greater.
• Professional telephone etiquette.
• Able to work with minimal supervision and in both individual and group environments.
• Successful completion of Credentialing 100, 101, and portions of 201 as it relates to verifier duties at the Parallon Credentialing Processing Center.

Benefits

Parallon offers a total rewards package that supports the health, life, career, and retirement of our colleagues. Available plans and programs include:

• Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health, and telemedicine services.
• Wellbeing support, including free counseling and referral services.
• Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage, and leaves of absence.
• Savings and retirement resources, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support, and financial wellbeing counseling.
• Education support through tuition assistance, student loan assistance, certification support, dependent scholarships, and a partnership with Galen College of Nursing.
• Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection, and consumer discounts.

Note: Eligibility for benefits may vary by location.