Credentialing Specialist RMG
About The Position
The Credentialing Specialist serves as the primary liaison for all aspects of the onboarding process at Riverside Medical Group. The role verifies provider credential documents, including Virginia medical licenses, federal DEA credentials, board certifications, and visas; credentials and recredentials healthcare providers with contracted payors; reviews applications; and monitors quality data and quality-control functions. The position reports to management staff and follows instructions and predefined guidelines, typically entering provider information into a database system of record. It also recommends best practices and commonly used processes for improving credentialing quality.
Requirements
- High school diploma or GED.
- Two years of active experience in credentialing or privileging.
- Experience in iCare/EPIC.
Nice To Haves
- Certified Provider Credentialing Specialist (CPCS) certification.
Responsibilities
- Complete and maintain initial and recredentialing or renewal provider applications accurately, including necessary follow-up to ensure timely completion.
- Ensure timely provider onboarding to mitigate patient access issues and support financial growth.
- Release pending claims for newly credentialed providers in a timely manner to support the Medical Group's financial stability.
- Build, update, and maintain provider information accurately in relevant electronic databases, including the credentialing database, CAQH, Echo, NPI, EMR/HER, and patient accounting system.
- Maintain accurate information in internal and external directories in accordance with CMS and other regulatory guidelines.
- Investigate credentialing issues, including payor participation status, supervising or collaborating physician agreements, billing, invalid place of service, CLIA, and NPI denial issues, and respond within two business days.
- Research legal sanctions related to licensure to ensure compliance with federal and state regulations.
- Identify and report issues before malpractice submission or upon discovery.
- Recommend best practices and commonly used processes for credentialing quality improvement.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
