Credentialing Specialist

OVP Health • Huntington, WV

9d • Onsite

About The Position

With assistance and oversight from senior team members, the Credentialing Specialist coordinates, monitors, and maintains the credentialing and re-credentialing process for outpatient office providers and Recovery Center providers. The role works with administration to support interpretation and compliance with applicable accrediting requirements and to develop and maintain working knowledge of the statutes and laws related to credentialing.

The position is full-time, Monday through Friday, 8:00 a.m. to 4:30 p.m., in a corporate office environment. The employee may occasionally need to arrive early or stay late. The role involves no regular exposure to blood, body fluids, or tissues, though unplanned tasks may involve such exposure. It also requires operating a computer and keyboard, lifting at least 25 pounds, and performing job duties in a facility with multiple levels and no elevator or mechanical transportation. Reasonable accommodations may be made for qualified individuals with disabilities.

Requirements

• High school diploma or GED.
• High-volume data-entry experience.
• Credentialing experience.
• CPR certification.
• Ability to lift a minimum of 25 pounds.
• Ability to perform job responsibilities in a facility with multiple levels and without an elevator or mechanical transportation.
• Ability to operate a computer and keyboard.

Nice To Haves

• Two years of experience in the medical industry.
• FQHC experience.
• Experience with multiple NPI numbers.

Responsibilities

• Maintain individual provider files with current information required for governmental and commercial payer credentialing applications.
• Maintain the internal provider grid, ensuring information is accurate and logins are available.
• Work with providers to apply for and annually renew professional, DEA, and Controlled Substance licenses.
• Complete applications to credential providers with commercial payers, Medicare, and Medicaid.
• Complete revalidation and re-credentialing requests issued by government and commercial payers.
• Credential or privilege new providers and re-credential current providers within outpatient settings and hospitals as needed.
• Work with the Chief Financial Officer and billing office to identify and resolve denials or authorization issues related to provider credentialing.
• Maintain accurate provider profiles in credentialing and HRIS software.
• Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED