Credentialing Specialist

Mountain State Oral & Facial Surgery; Hurricane (WV); On-site; USD 42,000 - 62,000; Full time

Benefits offered by this job

Health insurance

401k with match

Paid time off

Paid holidays

Wellness program

Employee assistance program

Job summary

Mountain State Oral & Facial Surgery in Hurricane, WV is seeking a Credentialing Specialist to maintain active status for all providers and manage credentialing packages for hospitals, centers, and payers. You will handle licensure, revalidations, and provider profiles across CAQH, PECOS, NPPES, and CMS databases.

The ideal candidate has at least 5 years of credentialing experience, strong Microsoft Office skills, and excellent communication and organizational abilities to thrive in a fast-paced

Qualifications

• High School Diploma or equivalent required.
• 5 years credentialing experience required.
• 5 years Microsoft Office experience preferred.
• Knowledge of AAAHC, NCQA, and TDI preferred.
• Experience maintaining provider profiles on CAQH, PECOS, NPPES, and CMS databases.

Responsibilities

• Maintain active provider files and update information for credentialing submissions.
• Maintain internal provider grid and ensure logins are available.
• Apply for and renew provider licenses (Professional, DEA, Controlled Substance).
• Complete revalidation requests from government payers.
• Complete credentialing applications for commercial payers, Medicare, and Medicaid.
• Perform re-credentialing for commercial payers and hospitals.
• Maintain provider profiles on CAQH, PECOS, NPPES, and CMS databases.
• Other duties as assigned.

Skills

Credentialing knowledge

Verbal communication

Written communication

Interpersonal skills

Detail oriented

Organizational skills

Time management

Education

High School Diploma or equivalent

Tools

Microsoft Office

Job description

Description

Our company has been a prominent provider specializing in oral and maxillofacial surgery throughout the state of West Virginia for over 25 years with recent expansion into the Kentucky and Virginia regions. Our mission is to provide an excellent and optimal patient experience in our state-of-the-art facilities. Our skilled surgeons utilize advanced oral and facial surgical techniques to deliver exceptional care. As an employer, we are focused on always striving to create a best-in-class experience for the entirety of our employees’ career from application to retirement. We seek team-oriented individuals with a desire to grow and develop within our progressing organization.

Not only do we offer competitive wages, but we also offer a significant benefits package which includes zero premium deduction medical/dental/vision insurance options, employer F.S.A./H.S.A. contributions, 401k with match, PTO, paid holidays, personal time, seasonal bonuses, company and partner discounts, employer-covered basic life insurance, voluntary benefits, wellness program, employee assistance program, and a weekday/daytime only schedule with short Fridays!

Job Title: Credentialing Specialist

Supervisory Responsibilities: None

Position Location: TV Corp, Hurricane, WV

Position Summary: Responsible for maintaining active status for all providers by successfully completing initial and subsequent credentialing packages as required by individual hospitals, surgery center, commercial payers, Medicare and Medicaid.

Duties and Responsibilities:

• Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications
• Maintain internal provider grid to ensure all information is accurate and logins are available
• Apply for and renew annually all provider licenses; Professional, DEA, Controlled Substance, etc.
• Complete revalidation requests issued by government payers
• Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid, hospitals
• Complete re-credentialing applications for commercial payers and hospitals
• Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases
• Other duties as assigned

Required Skills and Abilities:

• Knowledge of provider credentialing
• Excellent computer skills including Excel, Word, and Internet use
• Excellent verbal and written communication skills
• Excellent interpersonal skills
• Must be detail-oriented with excellent organizational skills
• Plans and prioritizes to meet deadlines
• Ability to function in fast paced and/ or stressful work environment
• Must adhere to company policies and procedure

Education and Experience:

• High School Diploma or equivalent required
• 5 years of credentialing experience required
• 5 years Microsoft Office experience preferred
• 5 years knowledge of AAAHC, NCQA, and TDI preferred

Physical Requirements

• Prolonged sitting at a desk
• Prolonged use of a computer
• Prolonged typing
• Some bending
• Health Care Plan (Medical, Dental & Vision)
• Retirement Plan (401k, IRA)
• Life Insurance (Basic, Voluntary & AD&D)
• Flexible Benefits Plan (FSA, HSA)
• Tuition Assistance
• Continuing Education
• Annual Scrub Allowance
• Paid Time Off (Vacation & 6 Holidays)
• Family Leave (Maternity, Paternity)
• Short Term & Long Term Disability
• Bereavement Leave
• Training & Development
• Free Food & Snacks
• Wellness Resources