Verification Examiner

Job Description

REQUIREMENTS

• 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.

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%.
• Performs other duties as assigned.
• Complies with all policies and standards.

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