Specialist, Physician Credentialing

Job Summary:

The Provider Credentialing Specialist is responsible for assisting in the onboarding and offboarding of providers and maintaining licensure for existing providers. This hire will partner with current credentialing colleagues and assist with the credentialing process to include: submission and tracking applications to providers; maintaining the data for all providers within the group and tracking the expiration of certification and licenses. ArchWell Health is a rapidly growing medical group across multiple states. An ideal candidate will have a background in healthcare, have strong attention to detail and organizational skills, and possess a strong customer-service orientation.

Duties/Responsibilities

• Oversee ongoing renewals and maintenance for all required provider licenses and credentials
• Gather credentialing documentation and relative information from incoming providers to ensure a smooth transition as they start
• Conduct background checks for incoming providers to ensure all ArchWell Health standards are met, and partner with Human Resources to resolve any escalations or concerns
• Verify provider state licensure for new and existing providers
• Assist with CAQH (Council for Affordable Quality Healthcare) attestations
• Update NPPES (National Plan and Provider Enumeration System)
• Complete payer portal attestations for multiple payers
  
  

Required Skills/Abilities:

• Familiarity with managed care plan credentialing, CAQH (Council for Affordable Quality Healthcare), and NPPES (National Plan and Provider Enumeration System).
• Must also be able to work and communicate in a professional manner to assist providers while maintaining a strong customer service orientation.
• Knowledge of medical terminology with the ability to effectively converse with providers, payers, and individuals at related entities
• Strong organization skills amidst competing priorities and deadlines
• Strong written and verbal communication skills
• Ability to work independently and conduct research while performing job duties
• Access to a private, remote work environment with reliable privacy and WiFi
  
  

Education and Experience:

• High school diploma or equivalent education (GED) required
• Associates or bachelors degree preferred, or a minimum of one (1) year of medical office or managed care experience
• 6-12 months of credentialing and enrollment experience preferred
• Proficient PC skills
• Embodies and serves as a role model of ArchWell Health’s Values:
• Be compassionate
• Strive for excellence
• Earn trust
• Show respect
• Stay resilient
• Always do the right thing
  

About ArchWell Health:

At ArchWell Health, we’re creating a community of caring designed to help our members stay healthy and engaged. By focusing on a strong provider-patient relationship, routine wellness, and staying active, our members enjoy a higher level of care and better quality of life after the age of 60. Everything we do is for seniors. We believe seniors should be heard, listened to, and given ample time by their physicians to live well later in life.

Our value-based care model is designed to prevent illnesses while keeping members healthy and happy in every aspect of their life. We deliver best-in-class primary care at comfortable, accessible neighborhood centers where older adults can feel at home and become part of a vibrant, wellness-focused community. We’re passionate about caring for older adults and united by the belief that caring has the power to change everything for our members.

ArchWell Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected classification.

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