Credentialing Specialist II
1 week ago
City/State
Newport News, VAOverview
Work Shift
First (Days) (United States of America)Job Summary
Under the supervision of a Credentialing Supervisor/Manager, the Credentialing Specialist II is responsible for specific aspects of Credentialing and Re-credentialing processing for a managed care organization, adhering to the National Committee for Quality Assurance, State and Federal regulations. They review, investigate, and process primary source verifications for facility, ancillary, medical and behavioral providers in a timely, efficient manner.CPCS - Certified Provider Credentialing Specialist (Preferred)
Requires thorough knowledge of managed care provider credentialing/re-credentialing principles, methods, regulations, and procedures normally acquired through a minimum of 2 years of directly related experience. Acceptable areas demonstrating experience would be direct work experience with organizations such as a CVO, MCO, HMO or Hospital Based Credentialing (MSO).
Qualifications:
ALD - Associate's Level Degree, HS - High School Grad or Equivalent (Required) Certified Provider Credentialing Specialist (CPCS) - Certification - Other/National Related experienceSkills
Active Listening, Communication, Judgment and Decision Making, Reading Comprehension, Speaking, Technology/Computer, WritingSentara Healthcare prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.
Per Clinical Laboratory Improvement Amendments (CLIA), some clinical environments require proof of education; these regulations are posted at ecfr.gov for further information. In an effort to expedite this verification requirement, we encourage you to upload your diploma or transcript at time of application.
In support of our mission "to improve health every day," this is a tobacco-free environment.
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