Credentialing Specialist Remote-Virginia

Exempt/Non-ExemptVirginia Residents Only.OrthoVirginia, Virginia's largest provider of expert orthopedic and therapy care, iscurrentlyseekingafull-time,experiencedCredit Specialistto join ourRichmondteam!This position is remote. CandidateMUSTreside in Virginia.Along with acollaborative, team-orientedwork environment, our outstandingemployment package includes competitive salaries, excellent medical,dental, andvision benefits, paid time off (PTO), a generous 401k incentive plan,short-term and long-term disability insurance, life insurance,and a company-wide wellness program.Position Summary

The Credentialing Specialist will assist in all Payer and Hospital Credentialing efforts. The key role of the Credentialing Specialist is to ensure that all new providers are successfully and seamlessly enrolled for privileges at all required facilities, and effectively enrolled with all contracted payers, along with performing all recredentialing responsibilities associated with these processes.

Primary Functions Accountabilities

Facilitate application and document collection for all new OV providers, including assisting providers new to the State with DEA and licensure applications.

Submit and follow all facility credentialing and recredentialing processes.

Submit provider applications and updates to Payers

Perform Primary Source Verifications

Maintain Provider data and current documentation in the Credentialing and Enrollment database

Ensure that all Providers are recredentialed within required timeframes.

Knowledge, Skills Abilities

Bachelor's degree preferred

Knowledge of Provider Enrollment processes

3 years work experience in practice or health plan credentialing required

Knowledge of Primary Source Verification processes

Knowledge of NCQA, URAC and TJC credentialing standards

Knowledge of Facility Accreditation standards

Experience with CAQH