Overview:
Join MDVIP as a Credentialing Specialist to assist in the insurance credentialing/re-credentialing process. The Credentialing Specialist coordinates and aids the Insurance Services department in the resolution of complex or advanced issues and cases. Compiles, runs, and completes various insurance related reports and presentations for management. Liaison between insurance carriers, commercial and federal clearing houses, federal regulatory credentialing as well as, state, county, and federal licensing on behalf of affiliated physicians for the purposes of insurance credentialing/re-credentialing.
MDVIP has consistently been recognized as a Great Place to Work® employer since 2018. (Greatplacetowork.com/certified-company/MDVIP) and was named by Fortune and Great Place to Work® as one of the 2023 Best Workplaces in Healthcare™ . This is a corporate based role, however a hybrid corporate office and work from home schedule may be available based on position and departmental needs.
Responsibilities:
- Coordinates all aspects of the credentialing process while delivering top quality customer service. This includes but is not limited to:
- Entering all pertinent data from applications into credentialing system and running daily/weekly reports, etc.
- Maintaining credentialing system processes, policies, procedures, and ensuring adherence to all requirements and taking corrective steps as needed.
- Identifying pertinent credentialing matters and provides analysis and resolution to management weekly.
- Establishes and communicates timelines with MDVIP affiliates or practices to ensure that schedules are met. Works directly with stakeholders to overcome any potential roadblocks.
- Prepares, reviews, and sends status reports on an as needed basis to affiliated physicians and stakeholders. Follows-up to ensure closure on outstanding cases.
- In coordination with legal staff, assesses all credentialing related materials and reports and coordinates with outside professional staff to verify all outside processes are completed.
- Provides analysis and recommendations to management for escalated issues. Assists in resolving escalated issues and urgent requests
This job profile is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Other duties, responsibilities and activities may change or be assigned at any time with or without notice.
Qualifications:
Associate degree and at least two years related business experience; or equivalent combination of education and experience where two years related experience equals one year of schooling.
- Certified Provider Credentialing Specialist (CPCS) highly desired.
- Related and proven experience with a successful track record in a similar corporate role focused on coordination or management of credentialing/re-credentialing processes for primary care physicians is highly desired.
- Insurance experience and healthcare knowledge preferred.
- Must be able to develop thorough knowledge of CAQH, PECOS & NPPES applications.
- CRM, EMR, and/or credentialing software experience required.
- Net Docs, credentialing software, athena, Salesforce experience preferred.
Additional information:
At no time may work be performed, or computer systems accessed, from outside of the U.S.
Individuals hired must be able to perform essential duties satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
MDVIP provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.
