Provider Credentialing Specialist II - Remote!
About The Position
Sentara Health Plan is currently hiring a Provider Credentialing Specialist II. This is a full-time, permanent position with a work shift of First (Days), 8am to 5pm 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 Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington (state), West Virginia, Wisconsin, and Wyoming. The Credentialing Specialist II works under the supervision of a Credentialing Supervisor/Manager and is responsible for specific aspects of Credentialing and Re-credentialing processing for a managed care organization. This role adheres to National Committee for Quality Assurance, State and Federal regulations. The specialist reviews, investigates, and processes primary source verifications for facility, ancillary, medical, and behavioral providers in a timely and efficient manner.
Requirements
- HS - High School Grad 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
- Experience in direct work experience with organizations such as a Credentials Verification Organization (CVO), MCO, HMO or Hospital Based Credentialing (MSO)
Nice To Haves
- CPCS - Certified Provider Credentialing Specialist preferred
- Experience in using Credential Stream or other similar programs like MDStaff or Cactus preferred
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.
- Process specific aspects of Credentialing and Re-credentialing for a managed care organization.
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
- Reimbursement for certifications and free access to complete CEUs and professional development
- Pet Insurance
- Legal Resources Plan
- Opportunity to earn an 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
