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
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.
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• 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.

