JOB SUMMARY: Completes timely and accurate functions related to credentialing of providers with occasional guidance. Ensures that credentialing records comply with requirements of regulatory and accrediting agencies including the Joint Commission and National Committee for Quality Assurance (NCQA), federal and state laws and delegated credentialing agreements.
Ensures all individuals meet qualifications of Joint Commission and NCQA Credentials Verification Organization (CVO) standards as well as other regulatory requirements and agreements.
Works proactively to resolve issues before providers and/or patients are impacted.
Performs primary source verification as applicable.
Collaborates with personnel in other departments and organizations.
Ensures appropriate documentation is maintained and that information is easily retrievable.
The responsibilities listed are a general overview of the position and additional duties may be assigned.
DATA ENTRY (INTERMEDIATE): - The ability to transcribe information from the original source into an electronic system according to written and verbal instructions efficiently and accurately.
ANALYTICAL SKILLS (NOVICE): - The process of identifying, evaluating, interpreting and organizing data. It includes sorting through data to identify patterns and establish relationships for decision making.
DISCRETION & PRIVACY (INTERMEDIATE): - The ability to use and keep information confidential in a secure setting.
DATA VERIFICATION (NOVICE): - The ability to verify data in an accurate manner.
DOCUMENTATION (NOVICE): - Ensures that all documentation is complete, accurate, thorough, and compliant.
Organizational Impact: Performs tasks that are typically routine that may impact team's performance with occasional guidance.
Problem Solving/ Complexity of work: Utilizes some discretion and research to solve routine problems.
Breadth of Knowledge: Applies knowledge of standards, established processes and procedure that apply to your own job.
Team Interaction: Provides guidance to entry level co-workers.
Vanderbilt University Medical Center is home to Vanderbilt University Hospital, The Monroe Carell Jr. Children’s Hospital at Vanderbilt, the Vanderbilt Psychiatric Hospital and the Vanderbilt Stallworth Rehabilitation Hospital. These hospitals experienced more than 61,000 inpatient admissions during fiscal year 2015. Vanderbilt’s adult and pediatric clinics treated nearly 2 million patients during this same period. Vanderbilt University Hospital and the Monroe Carell Jr. Children’s Hospital at Vanderbilt are recognized again this year by U.S. News & World Report’s Best Hospitals as among the nation’s best with 18 nationally ranked specialties. Vanderbilt University Medical Center is world renowned because of the innovation, work ethic and collegiality of its employees. From our health care advances to our compassionate care, Vanderbilt owes its accomplishments and reputation to staff and faculty who bring skill and drive and innovation to the medical center day after day. World-leading academic departments and comprehensive centers of excellence pursue scientific discoveries and transformational educational and clinical advances across the entire spectrum of health and disease.As t...he largest employer in middle Tennessee, we welcome those who are interested in ongoing development in a caring, culturally sensitive and professional atmosphere. Most of us spend so much of our lives at work, we want to be part of maintaining a workplace in which people support one another and encourage reaching for excellence. Many high-achieving employees stay at Vanderbilt because of the professional growth they experience and because of their appreciation of Vanderbilt’s benefits, public events and discussions, athletic opportunities, beautiful setting and, above all, sense of community and purpose.Vanderbilt and its employees share a set of mutual expectations that have been created with productivity, legality, fairness and safety always in mind. We believe that our investment in training and compensating employees multiplies in value when we enable individuals to deliver their best performance for the benefit of us all.