Job description
This role supports Verisys Credentialing, LLC, a NCQA-certified Credentials
Verification Organization (CVO) and NCQA-accredited Credentialing and
Recredentialing (CR) organization in the management of the MississippiCAN
(MSCAN) and Children's Health Insurance Program (CHIP) and credentialing
policy creation and enforcement.
Please note this is Consultant/Part-time contract position 5-10 hours per week!
Major Responsibilities:
- Medical Director and Chairperson of the CVO Credentialing Committee
- Oversight of the CVO Credentialing Committee
- Ensure meaningful range of committee members, leads discussions
regarding potential issues and/or concerns
- Review and evaluate the qualifications of providers (practitioners and facilities) for
initial credentialing and recredentialing
- When appropriate interview applicant to resolve questions about initial
credentialing and recredentialing
- Develop, coordinate, review, and make recommendations to the
credentialing process and policies at least annually
- Clarifies credentialing policies and procedures for Credentialing Committee
members
- Ensure all provider information requested is obtained and reviewed
- Ensure all files for review are complete and include all information required in the
Checklist
- Explain CVO Credentialing Committee decisions regarding non-approval of
applicant
Skills
- Ability to objectively review peers to determine appropriateness for network
participation
- Professionalism, honesty, discretion, and integrity
- Excellent verbal and written communication skills
- Strong project management, organizational, time-management and people skills
- Ability to use PC, Google-Suite, and Microsoft Office products
- Strong sense of confidentiality and personal responsibility
- Ability to relate well to a variety of individuals and a track record of being a team
player
- Demonstrate skills in providing excellent service to customers
- Current knowledge of issues related to care to individuals receiving Medicaid
- Ability to make decisions under pressure; ability to analyze data
- Demonstrated familiarity with credentialing
- High energy level, strong work ethic, and proactive problem-solving skill
- Ability to acquire needed data and information
- Knowledge of Operating Procedures
Requirements:
Pass Criminal Background Check- Eligible to participate in a state or federal healthcare program
- A current unrestricted license to practice medicine in Mississippi
- Enrolled and participating in MississippiCAN (MSCAN) and Children's Health
Insurance Program (CHIP)
- A minimum of 5 years of Mississippi Medicaid experience
- Preference given to candidates certified by the ABMS or AOA in his/her respective
special
Company Overview:
Verisys transforms provider data, workforce data, and relationship management. More than 400 healthcare, life science, and background screening organizations depend on us to credential providers, improve data quality, publish compliant provider directories, and conduct employment verifications. Our comprehensive solutions deliver accurate and secure information. As a result, we’re the largest outsourced credentials verification organization in the United States. Since we’ve partnered with the most complex institutions in healthcare for decades, we can help organizations of any size discover their true potential.
At Verisys, you can have a rewarding career on every level. In addition to challenging and meaningful work, you will have the chance to give back to your community, make a positive impact on the environment, participate in a range of diversity and inclusion initiatives, and find the support, coaching, and training it takes to advance your career. Our commitment to individual choice lets you customize aspects of your career path, your educational opportunities, and your benefits. And our culture of innovation means your ideas on how to improve our business and our clients will be heard.
Verisys is an Equal Opportunity Employer. We encourage all qualified persons of every heritage, nation, gender, veteran, or disability status, age, religion or other protected status to apply.
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