Credentialing Specialist Remote-Virginia
OrthoVirginia
Remote
credentialing
remote
credentialing
providers
insurance
exempt
expert
orthopedic
remote
team
medical
dental
pto
March 16, 2023
OrthoVirginia
Chester, 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
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
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