Provider Credentialing Specialist II - Remote!
About The Position
Sentara Health Plan is currently hiring a Provider Credentialing Specialist II - Remote! This is a full-time, permanent position working 40 hours per week, with work hours from 8 am to 5 pm EST, Monday through Friday. Remote opportunities are available in multiple states including Virginia, North Carolina, Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington (state), West Virginia, Wisconsin, Wyoming. The Credentialing Specialist II is responsible for specific aspects of Credentialing and Re-credentialing processing for a managed care organization, adhering to the National Committee for Quality Assurance, State and Federal regulations. They review, investigate, and process primary source verifications for facility, ancillary, medical and behavioral providers in a timely, efficient manner, under the supervision of a Credentialing Supervisor/Manager.
Requirements
- High School Graduate or Equivalent REQUIRED
- Minimum of 2 years of directly related experience REQUIRED
- Thorough knowledge of managed care provider credentialing/re-credentialing principles, methods, regulations, and procedures normally acquired through direct work experience with organizations such as a Credentials Verification Organization (CVO), MCO, HMO or Hospital Based Credentialing (MSO).
- CPCS - Certified Provider Credentialing Specialist preferred
- Experience in using Credential Stream is a plus or other similar programs like MDStaff or Cactus preferred
Nice To Haves
- CPCS - Certified Provider Credentialing Specialist
- Experience in using Credential Stream or other similar programs like MDStaff or Cactus
Responsibilities
- Review, investigate, and process primary source verifications for facility, ancillary, medical and behavioral providers in a timely, efficient manner.
- Adhere to National Committee for Quality Assurance, State and Federal regulations for Credentialing and Re-credentialing processing.
Benefits
- Medical, Dental, Vision plans
- Adoption, Fertility and Surrogacy Reimbursement up to $10,000
- Paid Time Off and Sick Leave
- Paid Parental & Family Caregiver Leave
- Emergency Backup Care
- Long-Term, Short-Term Disability, and Critical Illness plans
- Life Insurance
- 401k/403B with Employer Match
- Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
- Student Debt Pay Down – $10,000
- Pet Insurance
- Legal Resources Plan
- Annual discretionary bonus if established system and employee eligibility criteria is met.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
