Credentialing and Enrollment PSV Specialist

The primary responsibility of this position is to provide Primary Source Verification (PSV) for organizations who have contracted for Credentialing and Enrollment PSV. The following direct responsibilities are key to the success of the organization. The primary responsibility of this position is managing the PSV accounts as per the Policies and Procedures outlined by each organization. Responsibilities include gathering key provider data, ensuring data integrity regarding licensed providers and the organization, and provider management of key data elements. Overall Responsibilities include data entry of provider initial information, uploading applicable documentation into the InteCare database and creating the PSV initial and recredentialing files in shared drives. Scope of Role/Principal Responsibilities 1. Day-to-day responsibility for the management of the PSV process according to the policies and procedures of the organization. 2. Follow workflows and processes of PSV as written for the organization. 3. Provide oversight and management of key deadlines for each organization and manage workload to meet the PSV deadlines for operational success. 4. Communicate with the organizations regarding initial and recredentialing requirements and work with the provider/organization to streamline gathering the required documentation and/or information. 5. Complete the verification process within 30 days of the committee due date. 6. Prepare the credentialing or recredentialing file for the committee. 7. Communicate with the Cred and Enrollment account rep as data is received for them to begin their enrollment process. 8. Complete quality weekly updates and submit to organization liaisons regarding PSV. 9. Attend meetings with customers with whom InteCare is contracted to provide PSV and review customer policies and procedures to determine their needs. 10. Perform audits and secondary reviews of credentialing files with the PSV team before they are submitted to the customer to ensure all required elements are present and to collect dates for monitoring quality indicators. 11. . 12. Educate customer liaisons and providers about the credentialing/PSV/privileging process. 13. Monitor re-credentialing process to ensure timeliness. Ensure each provider is tracked with the time frames (one year, two years, etc) to begin re-credentialing, PSV, privileging 60 days before provider file expires with customer’s board. Customer will supply expiration date to InteCare. 14. Determine when and why to escalate issues to important customer contacts to ensure provider compliance with program, for example, poor results or provider non-responsive. 15. Participate as a team player with InteCare’s C&E structure and participate in meetings as assigned. 16. All other duties as assigned. Required Education, Training, and Professional Licenses & Credentials: High school education with no less than 1 year with administrative experience in the medical or behavioral health care and/or managed care industry. Required or Preferred Prior Work Experience: Experience with both medical and behavioral healthcare credentialing activities and experience with working in a professional team environment; experience with HRSA and NCQA requirements preferred. Expected Professional Competencies & Skills: · Excellent verbal and interpersonal skills in dealing with practitioners and administrators. · Excellent customer service skills · Excellent communication between the C&E Teams and co-workers · One year of experience in credentialing or privileging. · Experience with CAQH and state required credentialing applications. · Basic knowledge of NPPES · Basic knowledge of HRSA Compliance · Basic knowledge of accreditation standards · Fundamental understanding of medical and behavioral healthcare. · Excellent organization, time and task priority management skills. · Knowledge in personal computer applications including Microsoft Word, Excel, Office (email) operations as well as basic understanding of use of the internet. · Prior experience working in a professional environment · Excellent documentation skills, including writing notes, letters, reports. Working Conditions: Remote Travel: None