Job Description
At MVP Health Care, we're on a mission to create a healthier future for everyone - which requires innovative thinking and continuous improvement. To achieve this, we're looking for a Credentialing Specialist to join. If you have a passion for accuracy, integrity, and the broader impact of healthcare this is the opportunity for you.
What's in it for you:
Growth opportunities to uplevel your career. A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team. Competitive compensation and comprehensive benefits focused on well-being. An opportunity to shape the future of health care by joining a team recognized as a Best Place to Work for and one of the Best Companies to Work For in New York.
Qualifications you'll bring:
- Associate's degree or relevant training in a business school/health care
setting.
- The availability to work full-time, virtual
- Minimum of 2 years of employment experience working in the medical
community (medical office, medical records, medical billing), claims
processing, health care or health insurance required.
- Ability to meet and maintain required departmental quality and quantity
standards, ability to monitor and follow up on outstanding items identified.
- Ability to work independently, ability to handle multiple tasks at one time, ability to meet deadlines.
- Strict attention to detail.
- Curiosity to foster innovation and pave the way for growth
- Humility to play as a team
- Commitment to being the difference for our customers in every interaction
Your key responsibilities:
- Conducts RPA verifications and manual verifications of and processes credentialing, recredentialing, registration applications of providers and organizational facilities in accordance with MVP Policies, NCQA standards, CMS, NYS Department of Health and other regulatory agencies.
- Processes Credentialing and Recredentialing Applications for practitioners and organizational providers including preparing files for the MVP Credentials Committee.
- Conducts primary source verifications from various sources (hospitals, residency programs, Internet sources, physicians, practitioners, and insurance companies).
- Reviews files to ensure all necessary documentation and information has been received and conducts follow up, as necessary.
- Processes provider specialty/category change requests, ongoing monitoring files, early files, and staff review files.
- Data enters Credentialing information into sProvider (formerly Cactus) Credentialing software and performs cleanup projects, as directed.
- Enters Billing information into Facets. Monitor and maintain outstanding record reports and noncompliance reports to ensure regulatory compliance.
- Liaison between IPAs, Professional Relations, Provider Data Management, Network Development and Credentialing department.
- Ability to maintain confidentiality and adhere to regulatory compliance issues as they exist and change from time to time.
- Must be able to work additional hours as needed.
- Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer.
Where you'll be:
Virtual within New York State
Pay Transparency MVP Health Care is committed to providing competitive employee compensation and benefits packages. The base pay range provided for this role reflects our good faith compensation estimate at the time of posting. MVP adheres to pay transparency nondiscrimination principles. Specific employment offers and associated compensation will be extended individually based on several factors, including but not limited to geographic location; relevant experience, education, and training; and the nature of and demand for the role.
We do not request current or historical salary information from candidates.
MVP's Inclusion Statement At MVP Health Care, we believe creating healthier communities begins with nurturing a healthy workplace. As an organization, we strive to create space for individuals from diverse backgrounds and all walks of life to have a voice and thrive. Our shared curiosity and connectedness make us stronger, and our unique perspectives are catalysts for creativity and collaboration.
MVP is an equal opportunity employer and recruits, employs, trains, compensates, and promotes without discrimination based on race, color, creed, national origin, citizenship, ethnicity, ancestry, sex, gender identity, gender expression, religion, age, marital status, personal appearance, sexual orientation, family responsibilities, familial status, physical or mental disability, handicapping condition, medical condition, pregnancy status, predisposing genetic characteristics or information, domestic violence victim status, political affiliation, military or veteran status, Vietnam-era or special disabled Veteran or other legally protected classifications.
To support a safe, drug-free workplace, pre-employment criminal background checks and drug testing are part of our hiring process. If you require accommodations during the application process due to a disability, please contact our Talent team at (see below) .
Job Tags
Full time, Work at office,