Credentialing Specialist

This is a fully remote position, open to applicants in Virginia.

📋 Description

• Serve as the main point of contact for all elements of the provider onboarding process at Riverside Medical Group.

• Validate credentialing documents, including VA Medical License, Federal DEA, Board Certification, and Visas.

• Credential and recredential healthcare providers with contracted payers.

• Assess applications and oversee quality data and quality-control measures.

• Complete and manage provider applications for initial credentialing as well as re-credentialing/renewals, including necessary follow-ups.

• Ensure prompt provider onboarding to alleviate patient access concerns.

• Release pending claims for newly credentialed providers efficiently.

• Create, update, and maintain provider details in credentialing, CAQH, Echo, NPI, EMR/EHR, and patient accounting systems.

• Keep provider information current in both internal and external directories in compliance with CMS and regulatory standards.

• Investigate credentialing issues related to payer participation, physician agreements, billing, place of service, CLIA, and NPI denials.

• Address credentialing issues within 2 business days.

• Conduct research on legal sanctions pertaining to licensure and report any issues prior to malpractice submissions or upon discovery.

• Propose best practices and enhancements for the credentialing process.

⛳️ Requirements

• High School Diploma or GED (Required).

• Minimum of 2 years of active experience in credentialing/privileging (Required).

• Proficiency in iCare/EPIC (Required).

• Certified Provider Credentialing Specialist (CPCS) (Preferred).

🏝️ Benefits

• Competitive salary and benefits package.

• Opportunities for professional development and growth.

• Supportive work environment with a focus on teamwork and collaboration.