Specialist Credentialing
Specialist Credentialing
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$ 56000 - 65000
1 Vacancy
Job Description
About Our Company
Were a physicianled patientcentric network committed to simplifying health care and bringing a more connected kind of care.
Our primary multispecialty and urgent care providers serve millions of patients in traditional practices patients homes and virtually through VillageMD and our operating companies Village Medical Village Medical at Home Summit Health CityMD and Starling Physicians.
When you join our team you become part of a compassionate community of people who work hard every day to make health care better for are innovating valuebased care and leveraging integrated applications population insights and staffing expertise to ensure all patients have access to highquality connected care services that provide better outcomes at a reduced total cost of care.
Please Note: We will only contact candidates regarding your applications from one of the following domains: @summithealth @citymd @villagemd @villagemedical @westmedgroup @starlingphysicians or @bmctotalcare.
Job Description
At VillageMD were looking for a Credentialing Specialist to help us transform the way primary care is delivered and how patients are served. As a national leader on the forefront of healthcare weve partnered with many of todays best primary care physicians. Were equipping them with the latest digital tools. Empowering them with proven strategies and support. Inspiring them with better practices and consistent results.
We are creating care thats more accessible. Effective. Efficient. With solutions that are valuebased physiciandriven and patientcentered. To accomplish this were looking for individuals who share our sense of excellence are ready to embrace change and never settle for the status quo. Individuals who have the confidence to lead but the humility to never stop learning.
Could this be you
Integral to our team youll be responsible for all aspects of the payer credentialing recredentialing and privileging processes for launching all providers. In this role the Credentialing Coordinator is a key liaison between the providers the payers and VillageMD.
How you can make a difference
Obtain pertinent data from providers to initiate the credentialing process
Perform quality review audits of credentialing files
Maintain up to date data for each provider in databases
Track provider licenses certifications and professional liability insurances to ensure timely renewals.
Present files to Medical Director or Credentialing Committee as required
Maintains delegate files in accordance with the NCQA standards set forth by internal policies and procedures and local and federal regulatory requirements
Coordinates with all delegates to ensure timely and accurate receipt and transmission of additions terms and changes to network physician information
Assists with delegation audits as well as predelegation assessments including policy and procedure review and file review to ensure regulatory compliance as needed
Interact with internal departments varied levels of management physicians and physicians office staff effectively to accomplish credentialing timelines
Meet or exceed departmental timeframes and quality metrics on a consistent basis
Perform all other related duties as assigned
Skills for success
A willingness to learn take initiative and be resourceful
A bias for action and pragmatic solutions
Detail and resultsoriented ability to manage and prioritize requests and effectively communicate
The ability to be flexible in an ambiguous and dynamic environment
Ability to solve problems and establish trust
A low ego and humility; an ability to gain trust through strong communication and doing what you say you will do
Strong desire to learn and grow within a fastgrowing company
Experience to drive change
Experience in managed care credentialing and/or Medical Staff service setting specifically working with individual providers and Credentialing Committee members is preferred.
Experience with data management and entry utilizing industry platforms such as Cactus CredentialStream or Echo.
Demonstrated skills in problem solving analysis and resolution.
Must be able to function independently possess demonstrated flexibility in multiple project management capabilities.
Must comply with HIPAA rules and regulations.
Demonstrated extensive knowledge of NCQA certification requirements the hospital and privileging appointment and reappointment processes state licensing requirements primary source verifications as well as credentialing database maintenance.
Working knowledge ofpayer credentialing rules and regulations preferred.
- CPCS Certification is a plus certification must be obtained within 2 years of employment and maintained thereafter
How you will thrive
In addition to competitive salaries a 401k program eligibility for bonus and a valuable health benefits package VillageMD offers paid parental leave pretax savings on commuter expenses and generous paid time off. You work in a highlycollaborative conscientious forwardthinking environment that welcomes your experience and enables you to make a significant impact from Day 1. Most importantly you make a difference. You see a clear connection between your daily work on VillageMD products and services and the advancement of innovative solutions and improved quality of healthcare for providers and patients.
Our unique VillageMD culture how inclusion and diversity make the difference
At VillageMD we see diversity and inclusion as a source of strength in transforming believe building trust and innovation are best achieved through diverse perspectives. To us acceptance and respect are rooted in an understanding that people do not experience things in the same way including our healthcare seeking employment at VillageMD are considered without regard to race religion color national origin gender sexual orientation age marital status veteran status or disability status.
Explore your future with VillageMD today
Travel Yes to clinical locations and business office locations as necessary.
Work Location: Hybrid; may require NJ inoffice attendance based on the business needs. Remote work from home may be allowed at the discretion of leadership. Hours 8:00 am 5:00pm
Salary Range: Depending on experience $56000$65000
About Our Commitment
Total Rewards at VillageMD
Our team members are essential to our mission to reshape healthcare through the power of connection. VillageMD highly values the critical role that health and wellness play in the lives of our team members and their families. Participation in VillageMDs benefit platform includes Medical Dental Life Disability Vision FSA coverages and a 401k savings plan.
Equal Opportunity Employer
Our Companyprovides equal employment opportunities EEO) to all employees and applicants for employment without regard to and does not discriminate on the basis of race color religion creed gender/sex sexual orientation gender identity and expression (including transgender status) national origin ancestry citizenship status age disability genetic information marital status pregnancy military status veteran status or any other characteristic protected by applicable federal state and local laws.
Safety Disclaimer
OurCompanycares about the safety of our employees and Companydoes not use chat rooms for job searches or Companywill never request personal information via informal chat platforms or unsecure Companywill never ask for money or an exchange of money banking or other personal information prior to the inperson interview. Be aware of potential scams while job seeking. Interviews are conducted at selectOur Companylocations during regular business hours only. For information on job scams visit file a complaint at Experience:
Unclear Seniority
Employment Type
Full-Time
Key Skills
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