Credentialing Specialist RMG

Riverside Hospital; Newport News (VA); On-site; USD 29,000 - 38,000; Full time

Job summary

Riverside Hospital in Newport News, Virginia is seeking a Credentialing Specialist to manage onboarding and credentialing for the Riverside Medical Group. You will verify licenses, credentials and recredentials, keep data in multiple databases, and support quality improvements in the credentialing process.

The role requires 2 years of credentialing experience and proficiency with iCare/EPIC, with CPCS preferred.

Qualifications

• High School Diploma or GED is required.
• 2 years of active credentialing/privileging experience is required.
• Experience with iCare/EPIC is required.

Responsibilities

• Accurately complete and maintain provider applications (Initial and Re-credentialing/Renewals).
• Ensure timely onboarding of providers to support access and financial growth.
• Release pending claims for newly credentialed providers to support financial stability of the Medical Group.
• Maintain provider information in Credentialing Database, CAQH, Echo, NPI, EMR/HER and patient accounting systems to ensure data integrity.
• Keep internal/external directories up to date per CMS and regulatory guidelines.
• Investigate credentialing issues (payor status, agreements, billing, CLIA, NPI denials) and respond within 2 business days.

Education

High School Diploma or GED

Tools

iCare/EPIC

Job description

Newport News, Virginia

Hiring Range

$21.30 - $27.68/Hourly

Actual pay is determined based on job-related factors such as relevant experience, education, credentials, skills, internal equity, and business needs.

Overview

Functions as the primary liaison for all aspects of the onboarding process and Riverside Medical Group. Verifies credential documents (VA Medical License, Federal DEA, Board Certification and Visas), credentials and recredentials healthcare providers with contracted payors, reviews applications, monitors quality data and all applicable functions within the directive of quality control in the organization. Reports to the management staff at the organization and relies on instruction and pre-defined guidelines to perform various functions of the job, typically entering all information regarding providers into a database system of record. Recommends best practice or commonly used processes for quality improvement in credentialing.

What you will do

• Accurately complete and maintain the following Provider applications (both Initial and Re-credentialing/Renewals) as required (completion of applications includes conducting any necessary follow-up to ensure timely completion of process).
• Ensure timely Provider Onboarding to mitigate access issues for patients which helps to drive financial growth.
• Responsible for timely release of pending claims for newly credentialed providers to ensure financial stability for the Medical Group.
• Accurately builds, updates and maintains provider information electronically in all appropriate databases (Credentialing Database, CAQH, Echo, NPI, EMR/HER and patient accounting system) to ensure data integrity.
• Maintain accurate information in internal and external directories per CMS and other regulatory guidelines.
• Investigates problems related to credentialing, including but not limited to, payor participation status, supervising/collaborating physician agreements, billing, invalid place of service, CLIA and NPI denials issues. Responds within 2 business days. Researches legal sanctions regarding licensure to ensure compliance with Federal and State regulations. Finds and reports all issues prior to malpractice submission or upon discovery.

Qualifications

Education

• High School Diploma or GED, (Required)

Experience

• 2 years Active experience in credentialing/privileging (Required)
• in iCare/EPIC (Required)

Licenses and Certifications

• Certified Provider Credentialing Specialist (CPCS) (Preferred)

To learn more about being a team member with Riverside Health System visit us at https://www.riversideonline.com/careers .