Credentialing Specialist RMG

101 Riverside Hospital, Inc.; United States; On-site; USD 29,000 - 38,000; Full time

Job summary

Riverside Health System seeks a credentialing specialist to manage provider applications, onboarding and credentialing activities for Riverside Medical Group. You will ensure data accuracy across multiple databases and assist with timely payor-related processes.

The role requires 2 years of credentialing experience, proficiency with iCare/EPIC, and familiarity with CMS regulations. CPCS preferred; high school diploma or GED required.

Qualifications

• 2 years active experience in credentialing/privileging (Required) in iCare/EPIC (Required).
• High School Diploma or GED (Required).
• Certified Provider Credentialing Specialist (CPCS) (Preferred).

Responsibilities

• Accurately complete and maintain Provider applications (Initial and Re-credentialing/Renewals) as required.
• Ensure timely Provider Onboarding to mitigate access issues for patients and drive financial growth.
• Release pending claims for newly credentialed providers to ensure financial stability for the Medical Group.
• Build and maintain provider information in Credentialing Database, CAQH, Echo, NPI, EMR/HER and patient accounting system.
• Maintain accurate information in internal and external directories per CMS and regulatory guidelines.
• Investigate problems related to credentialing, including payor status and denials, respond within 2 business days.
• Research licensure sanctions to ensure compliance with Federal and State regulations.

Skills

Credentialing/privileging experience

Education

High School Diploma or GED

CPCS (Preferred)

Tools

iCare/EPIC

CAQH

EMR/HER

NPI

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.

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.

If loving your work is important to you, consider a career at Riverside. By joining our team, you can make a difference in people's lives. Our mission is to care for others as we would care for those we love. We extend that sense of caring to every patient, resident and customer, as well as to each member of our team. We offer care at all stages of life, in hundreds of locations, giving you room to grow your career, along with great benefits and perks. At Riverside Health, your trust and safety are our top priorities.