Verification Examiner

American Specialty Health Incorporated is seeking a Verification Examiner to complete verification of practitioner credentials according to department standards accreditation standards regulatory requirements and health plan expectations.

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.

Mobility

Primarily sedentary able to sit for long periods of time.

Physical Requirements

Ability to speak see and hear other personnel and/or objects.  Ability to communicate both in verbal and written form. Ability to travel within the facility. Capable of using a telephone and computer keyboard.  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 (including pregnancy childbirth related medical conditions breastfeeding and reproductive health decision-making) gender gender identity gender expression race color religion (including religious dress and grooming practices) creed 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.

Please view Equal Employment Opportunity Posters provided by OFCCP here .

If you are a qualified individual with a disability or a disabled veteran you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation contact our Human Resources Department at (800) 848-3555 x6702.

ASH will not discharge or in any other manner discriminate against employees or applicants because they have inquired about discussed or disclosed their own pay or the pay of another employee or applicant. However employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information unless the disclosure is (a) in response to a formal complaint or charge (b) in furtherance of an investigation proceeding hearing or action including an investigation conducted by the employer or (c) consistent with the Company’s legal duty to furnish information.

#LI-Remote #Healthcare #Claims #DataEntry #Administratvie #Data