Provider Credentialing Specialist II

Location

Alabama + 25 moreAll locations: Alabama | Florida | Idaho | Kansas | Louisiana | Maine | Nebraska | Nevada | New Hampshire | North Carolina | North Dakota | Ohio | Oklahoma | Maryland | Minnesota | Pennsylvania | South Carolina | South Dakota | Tennessee | Texas | Utah | Virginia | Washington | West Virginia | Wisconsin | Wyoming

Posted

32 days ago

Salary

$1.7K - $2.9K / month

Seniority

Mid Level

High School2 yrs expExperience acceptedEnglish

Job Description

Provider Credentialing Specialist II

Sentara Health

• Responsible for specific aspects of Credentialing and Re-credentialing processing for a managed care organization • Adhering to the National Committee for Quality Assurance, State and Federal regulations • Review, investigate, and process primary source verifications for facility, ancillary, medical and behavioral providers in a timely, efficient manner

Job Requirements

  • HS - High School Grad or Equivalent REQUIRED
  • Minimum of 2 years of directly related experience REQUIRED
  • Thorough knowledge of managed care provider credentialing/re-credentialing principles, methods, regulations, and procedures normally acquired through experience with organizations such as a Credentials Verification Organization (CVO), MCO, HMO or Hospital Based Credentialing (MSO)
  • CPCS - Certified Provider Credentialing Specialist preferred
  • Experience in using Credential Stream or other similar programs like MDStaff or Cactus preferred.

Benefits

  • Medical, Dental, Vision plans
  • Adoption, Fertility and Surrogacy Reimbursement up to $10,000
  • Paid Time Off and Sick Leave
  • Paid Parental & Family Caregiver Leave
  • Emergency Backup Care
  • Long-Term, Short-Term Disability, and Critical Illness plans
  • Life Insurance
  • 401k/403B with Employer Match
  • Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
  • Student Debt Pay Down – $10,000
  • Reimbursement for certifications and free access to complete CEUs and professional development
  • Pet Insurance
  • Legal Resources Plan
  • Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.

Related Job Pages

More Credentialing Specialist Jobs

Full TimeRemoteTeam 201-500H1B No Sponsor

• The Credentialing Specialist will be responsible for timely submission and follow-up for institutional and individual provider credentialing, contracting, and re-credentialing with health insurance payors across multiple states and service lines. • Assists in verifying and monitoring credentials of healthcare providers and completing facility applications as needed. • Maintains confidential files of providers records to meet company and compliance standards. • Prepare and submit credentialing applications and supporting documentation for the purpose of enrolling groups and providers with Commercial, Medicare, and Medicaid networks. • Follow up on the status of applications for providers with payers, tracking progression of pending and completed work. • Maintains accurate and up-to-date database of information including provider credentials and payer statuses. • Works closely with internal teams to communicate approvals and work through denials as necessary. • Maintains knowledge of current payer requirements across multiple states and service lines. • Maintain strict level of confidentiality and HIPAA compliance. • Familiarity with state licensing requirements and provider onboarding tasks. • Familiarity with various payer portals and CAQH. • Contact providers and payers, by phone or email, for updates and/or to request missing information. • Ensure group and provider information is current/accurate with health insurance payers. • Assist with facility credentialing applications as needed.

Kansas