Associate, Credentialing Specialist

MVP Health Care

5d•$24 - $32•Remote

About The Position

Join Us in Shaping the Future of Health Care At MVP Health Care, we’re on a mission to create a healthier future for everyone. That means embracing innovation, championing equity, and continuously improving how we serve our communities. Our team is powered by people who are curious, humble, and committed to making a difference—every interaction, every day. We’ve been putting people first for over 40 years, offering high-quality health plans across New York and Vermont and partnering with forward-thinking organizations to deliver more personalized, equitable, and accessible care. As a not-for-profit, we invest in what matters most: our customers, our communities, and our team. What’s in it for you: Growth opportunities to uplevel your career A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team Competitive compensation and comprehensive benefits focused on well-being An opportunity to shape the future of health care by joining a team recognized as a Best Place to Work For in the NY Capital District, one of the Best Companies to Work For in New York, and an Inclusive Workplace. You’ll contribute to our humble pursuit of excellence by bringing curiosity to spark innovation, humility to collaborate as a team, and a deep commitment to being the difference for our customers. Your role will reflect our shared goal of enhancing health care delivery and building healthier, more vibrant communities.

Requirements

Associate’s degree or relevant training in a business school/health care setting.
The availability to work full-time, virtual
Minimum of 2 years of employment experience working in the medical community (medical office, medical records, medical billing), claims processing, health care or health insurance required.
Ability to meet and maintain required departmental quality and quantity standards, ability to monitor and follow up on outstanding items identified.
Ability to work independently, ability to handle multiple tasks at one time, ability to meet deadlines.
Strict attention to detail.
Curiosity to foster innovation and pave the way for growth
Humility to play as a team
Commitment to being the difference for our customers in every interaction

Responsibilities

Conducts RPA verifications and manual verifications of and processes credentialing, recredentialing, registration applications of providers and organizational facilities in accordance with MVP Policies, NCQA standards, CMS, NYS Department of Health and other regulatory agencies.
Processes Credentialing and Recredentialing Applications for practitioners and organizational providers including preparing files for the MVP Credentials Committee.
Conducts primary source verifications from various sources (hospitals, residency programs, internet sources, physicians, practitioners, and insurance companies).
Reviews files to ensure all necessary documentation and information has been received and conducts follow up, as necessary.
Processes provider specialty/category change requests, ongoing monitoring files, early files, and staff review files.
Data enters Credentialing information into sProvider (formerly Cactus) Credentialing software and performs cleanup projects, as directed.
Enters Billing information into Facets.
Monitor and maintain outstanding record reports and noncompliance reports to ensure regulatory compliance.
Liaison between IPAs, Professional Relations, Provider Data Management, Network Development and Credentialing department.
Ability to maintain confidentiality and adhere to regulatory compliance issues as they exist and change from time to time.
Must be able to work additional hours as needed.
Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer.