Provider Credentialing Specialist II - Remote!

Provider Credentialing Specialist II - Remote!

Sentara Health Plan is currently hiring a Provider Credentialing Specialist II - Remote!

Status: Full-time, permanent position (40 hours)

Work hours: 8am to 5pm EST, M-F

Location: Remote opportunities available in the following states: Virginia, North Carolina, Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington (state), West Virginia, Wisconsin, Wyoming

Job Responsibilities

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.

Education

• HS - High School Grad or Equivalent REQUIRED

Certification/License

• None required

Experience

• Minimum of 2 years of directly related experience REQUIRED; With thorough knowledge of managed care provider credentialing/re-credentialing principles, methods, regulations, and procedures normally acquired through a. Acceptable areas demonstrating experience would be direct work experience with organizations such as a Credentials Verification Organization (CVO), MCO, HMO or Hospital Based Credentialing (MSO).
• CPCS - Certified Provider Credentialing Specialist preferred
• Experience in using Credential Stream is a plus or other similar programs like MDStaff or Cactus preferred

Pay Transparency

We provide market-competitive compensation packages, inclusive of base pay, incentives, and benefits. The base pay rate for Full Time employment is: $17.31 - 23.08 - 28.85. Additional compensation may be available for this role such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Sentara Health Plans provides health plan coverage to close to one million members in Virginia. We offer a full suite of commercial products including employee-owned and employer-sponsored plans, as well as Individual & Family Health Plans, Employee Assistance Programs and plans serving Medicare and Medicaid enrollees.

Our quality provider network features a robust provider network, including specialists, primary care physicians and hospitals.

We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services—all to help our members improve their health.

Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth.

Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!