Provider Credentialing Specialist

Privia Health

1d•$25 - $26

About The Position

The Credentialing Specialist is responsible for all aspects of the credentialing, re-credentialing and privileging processes for all providers in Privia’s high-performance medical group.

Requirements

1+ years experience in managed care credentialing Primary Source Verification
Demonstrated skills in problem solving and analysis and resolution
Must be able to function independently, possess demonstrated flexibility in multiple project management
Must comply with HIPAA rules and regulations
An individual with the ability to communicate appropriately and effectively with practitioners, internal stakeholders, and providers; including sensitive and confidential information
High level of attention to detail with exceptional organizational skills

Responsibilities

Follows documented process to ensure timely processing of Primary Source Verification completion for initial and recredentialing.
Follows guidelines in alignment with all NCQA, CMS, and state requirements as related to the provider credentialing.
Works with both internal and external stakeholders to resolve complex provider credentialing issues.
Supports special projects requiring knowledge of delegated and non-delegated health plan requirements
Maintains up-to-date data (expireables) for each provider in credentialing databases and CAQH;; ensures timely renewal of licenses, certifications, COI’s etc.
Maintains confidentiality of provider information
Assist in managing the flow of information between internal stakeholders
Coordinate and prepare reports under the direction and supervision of the manager
Record and track credentialing statistics
Other duties as assigned