Credentialing Specialist-Managed Care

VHCHealth; Alexandria (VA); On-site; USD 80,000 - 100,000; Full time

Job summary

An established industry player is seeking a Credentialing Specialist to manage insurance plan credentialing and enrollment for healthcare providers. This role involves collaborating with credentialing associates to ensure timely participation in insurance plans and maintaining accurate data across systems. The ideal candidate will have a strong background in managed care and credentialing processes, contributing to a collegial environment focused on patient-centered care. Join a forward-thinking organization that values innovation and community engagement in the vibrant Northern Virginia area, where you can enjoy a rich cultural experience and a thriving professional landscape.

Qualifications

• One year of credentialing experience in a healthcare setting is preferred.
• Bachelor's degree in a healthcare field is preferred.

Responsibilities

• Responsible for physician and advanced practice provider credentialing.
• Maintains data in various systems for accuracy and re-credentialing.

Skills

Insurance Plan Credentialing

Data Maintenance

Knowledge of Managed Care

Communication Skills

Education

Bachelor's degree in a healthcare related field

Job description

Position Title: Credentialing Specialist - Managed Care

Purpose & Scope:

Responsible for physician and advanced practice provider insurance plan credentialing and enrollment. Works with credentialing and contracting associates with government and commercial payers to expedite effective dates of insurance participation for new providers. Maintains data in various systems to ensure accuracy and successful re-credentialing. Assists with facility credentialing as necessary.

Education:

Bachelor's degree in a healthcare related field is preferred.

Experience:

One year of insurance plan credentialing experience in a physician practice, hospital or managed care, one year of knowledge of managed care including data maintenance of facility and/or profiles, or one year of credentialing experience in a medical office setting is preferred.

Certification/Licensure:

None.

AWARDS & RECOGNITION

• Washington Commanders: selected VHC Health as its women’s health partner because of the health system’s continued commitment to advancing women’s health, reducing the stigma of mental health, and creating greater access to care in the Washington, DC metro region.

• Received a top ranking in Newsweek’s World’s Best Hospitals for the fourth year in a row. Ranking over 2,800 hospitals in 28 countries, this study asked 85,000 medical experts across the world to participate in an online survey covering topics such as recommendation of hospital, satisfaction of patient care, quality of care for specific treatments, among other factors.

• Recognized by the Women’s Choice Award for Best Hospital in eight categories: bariatric surgery, obstetrics, heart care, minimally invasive surgery, orthopedics, cancer care, comprehensive breast care, women’s services, mammogram and patient experience. This award is graded based on the best publicly available information, patient surveys and accreditation information, and the Women’s Choice Award delivers a simplified, objective ranking to each category.

• Named a 2023 Best Cancer Hospital by Newsweek. One of 175 hospitals and just three in the Washington, DC metro region to be included in the rankings.

• Named best hospital for billing ethics by Money magazine and The Leapfrog Group. This is the first-ever Leapfrog Best Hospitals ranking to help patients make educated decisions about which institutions are best for the money.

OUR COMMUNITY

• Living in Northern Virginia, one of the best places to live near D.C., you can have it all: a lucrative job at a forward-thinking company – plus access to the country’s greatest historical sites, a bustling café culture, active nightlife and concert going, a thriving wine region, seven professional sports teams, and a mild four-season climate with year-round kayaking, biking, and hiking.

• Arlington is home to the Pentagon, and the Arlington National Cemetery.

• Home to more than 100 U.S. and global corporate headquarters, including the 6th highest number of Fortune 500 companies.

• Northern Virginia is one of the fastest growing and most diverse communities in the United States.

• Fairfax County has many of the highest ranking schools in the nation according to U.S. News and World Reports.

• Arlington County also offers outstanding schools - about 94 percent of all graduating high school seniors in Arlington go on to attend college.

• Two major airports with direct flights to 109 domestic and 60 international destinations.

• Northern Virginia has many recreational and community amenities including: over 89 miles of biking/jogging trails, 167 public parks, approximately 14 community centers, 7 live stage theaters, 8 libraries, and 652 restaurants.

• Minutes to the Kennedy Center, Smithsonian Museums, Tyson’s Corner, and Wolftrap National Park for the Performing Arts.

• Whether you choose to live in Arlington County, Fairfax County, City of Alexandria or in any of the other great areas in the DC area, you will have little problem in finding a location that is right for you.

We look forward to hearing from qualified candidates interested in joining us in a highly collegial environment where the patient is at the center of what we do.