Full-Time Credentialing Specialist

Credentialing Specialist

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

1. Follows documented process for timely Primary Source Verification completion for initial and re-credentialing.
2. Adheres to NCQA, CMS, and state requirements for provider credentialing.
3. Works with internal and external stakeholders to resolve complex provider credentialing issues.
4. Supports special projects requiring knowledge of delegated and non-delegated health plan requirements.
5. Maintains up-to-date provider data (expireables) in credentialing databases and CAQH.
6. Ensures timely renewal of licenses, certifications, COI's, etc.
7. Maintains confidentiality of provider information.
8. Assists in managing information flow between internal stakeholders.
9. Coordinates and prepares reports under manager supervision.
10. Records and tracks credentialing statistics.
11. Other duties as assigned.

Experience & Skills

• 1+ years experience in managed care credentialing and Primary Source Verification.
• Demonstrated problem-solving, analysis, and resolution skills.
• Ability to function independently and demonstrate flexibility in multiple project management situations.
• Complies with HIPAA rules and regulations.
• Communicates effectively and appropriately with practitioners, internal stakeholders, and providers, including sensitive and confidential information.
• High attention to detail and exceptional organizational skills.
• Independent judgment in interpreting guidelines of applicable regulatory bodies.

Salary & Benefits

Salary range: $50,000.00 - $55,000.00 base pay, excluding bonuses or benefits. Annual bonus (target 10%) and restricted stock units available. Base pay determined by experience, education, and geographic location.

Remote Work Requirements

• 5 Mbps minimum download speed.
• 3 Mbps minimum upload speed.
• Eligible for expense reimbursement for remote workers to offset internet costs.

EEO Statement

Privia Health is committed to fostering a diverse and inclusive environment.

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