Full-Time Credentialing Specialist

Credentialing Specialist

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.

1. Follows documented process to ensure timely processing of Primary Source Verification completion for initial and recredentialing.
2. Follows guidelines in alignment with all NCQA, CMS, and state requirements as related to the provider credentialing.
3. Works with both 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 data (expireables) for each provider in credentialing databases and CAQH; ensures timely renewal of licenses, certifications, COI’s etc.
6. Maintains confidentiality of provider information
7. Assist in managing the flow of information between internal stakeholders
8. Coordinate and prepare reports under the direction and supervision of the manager
9. Record and track credentialing statistics
10. Other duties as assigned

Requirements:

• + 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
• Exercise independent judgment in interpreting guidelines of applicable regulatory bodies.

Salary: $50,000.00 - $55,000.00 (base pay, excluding bonuses and benefits)

Technical Requirements (Remote Workers):

• Minimum Download Speed: 5 MBPS
• Minimum Upload Speed: 3 MBPS

Eligibility:

• Annual bonus: 10%

Additional Notes:

• Benefits: Medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs

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