Job Details

Verification Examiner I

American Specialty Health Incorporated (ASH) is seeking a Verification Examiner I to join our Credentialing department. The primary function of this position is to complete verification of practitioner credentials according to department standards, accreditation standards, regulatory requirements, and health plan expectations.

Remote Worker Guidelines: 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 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. The internet connection must have a consistent 50 down/10 up Mbps minimum internet speed. 100 down/20 up is recommended to support higher quality video meetings.

Responsibilities:

• Performs verification and updates PROMIS according to standards and health plan expectations.
• Completes 20 or more primary source verifications (PSV) daily.
• Production sheet is shared with supervisor daily.
• 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 utilizing ZEBU EpStaff and sanctions from the 54 governing bodies including NPI and SSDMF.
• 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.
• Maintains an accuracy rate of no less than 99%.

Qualifications:

• High School Diploma or GED certificate required.
• 1 year computer experience including word processing and spreadsheet applications required.
• Industry experience preferred.
• Data Entry experience preferred.
• Proficient in MS Office.
• Excellent verbal communication skills with the ability to provide excellent customer service over the telephone.

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.

Mobility:

• Primarily sedentary, able to sit for long periods of time.

Physical Requirements:

• Ability to see, speak, and hear other personnel and/or objects. Ability to communicate both in verbal and written form. Ability to travel within and around the facility or Work from Home (WFH) environment. Capable of using a telephone, computer keyboard, and mouse. Ability to lift up to 10 lbs.

Environmental Conditions:

• Work-from-home (WFH) environment.

American Specialty Health is an Equal Opportunity/Affirmative Action Employer.

All qualified applicants will receive consideration for employment without regard to sex, gender, race, color, religion, national origin, citizenship, ancestry, physical or mental disability, legally-protected medical condition, marital status, age, sexual orientation, genetic information, military or veteran status, political affiliation, or any other basis protected by applicable local, federal or state law.