Credentialing Specialist

Job not on LinkedIn

🔥 7 minutes ago

⚔️ Virginia – Remote

⚔️ Virginia – Remote

💵 $21 - $27 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Riverside Health

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 1915

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 Non-profit

Healthcare • Healthcare Insurance • Non-profit

Riverside Health is a comprehensive health care provider offering a wide range of medical services, including primary care, urgent care, specialty care, and emergency care. The organization is dedicated to enhancing the health and well-being of the communities it serves through compassionate care, innovative treatment options, and a commitment to excellence. Riverside Health provides access to specialized services such as mental health care, women's health, orthopedic services, cancer care, and more. This organization also focuses on education and support for various life stages, and offers resources like clinical trials and wellness education through blogs and podcasts. They maintain a strong community presence with outreach programs and partnerships intended to improve health. Riverside Health also offers digital access to health records through MyChart, ensuring patients can manage their health information conveniently. Their mission is to care for others with the same dedication they would show to their loved ones, focusing on patient-centered care and community impact.

📋 Description

• Function as the primary liaison for all aspects of the provider onboarding process at Riverside Medical Group • Verify credential documents, including VA Medical License, Federal DEA, Board Certification, and Visas • Credential and recredential healthcare providers with contracted payors • Review applications and monitor quality data and quality-control functions • Complete and maintain provider applications for initial credentialing and re-credentialing/renewals, including necessary follow-up • Ensure timely provider onboarding to mitigate patient access issues • Release pending claims for newly credentialed providers in a timely manner • Build, update, and maintain provider information in credentialing, CAQH, Echo, NPI, EMR/HER, and patient accounting systems • Maintain provider information in internal and external directories according to CMS and regulatory guidelines • Investigate credentialing issues involving payor participation, physician agreements, billing, place of service, CLIA, and NPI denials • Respond to credentialing issues within 2 business days • Research legal sanctions regarding licensure and report issues before malpractice submission or upon discovery • Recommend best practices and process improvements in credentialing

🎯 Requirements

• High School Diploma or GED (Required) • 2 years active experience in credentialing/privileging (Required) • Experience in iCare/EPIC (Required) • Certified Provider Credentialing Specialist (CPCS) (Preferred)

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