Credentialing Specialist

OVP Health • Huntington, WV

7d • Onsite

About The Position

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

The role maintains provider information and profiles across internal files and systems and external credentialing databases, coordinates provider licenses, and completes payer credentialing, revalidation, and re-credentialing applications. The Specialist also works with finance and billing colleagues to identify and resolve denials or authorization issues related to provider credentialing.

This is a full-time position with hours of 8:00 a.m. to 4:30 p.m., Monday through Friday, in a corporate office environment. The employee may be required to come in early or stay late if the need arises. The role may involve unplanned exposure to blood, body fluids, or tissues, though there is no regular exposure. The work environment is smoke-free.

Requirements

• High school diploma or G.E.D.
• 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 needed 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 from government and commercial payers.
• Credential and privilege new providers and re-credential current providers in 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 in CAQH, PECOS, NPPES, and CMS databases.

What This Job Offers

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