Provider Credentialing & Compliance Specialist

OVP HEALTH; Huntington (WV); On-site; USD 45,000 - 68,000; Full time

Job summary

OVP Health is seeking a Credentialing Specialist to coordinate and monitor credentialing for outpatient providers and Recovery Center staff. You will maintain provider files, assist with license renewals, and ensure compliance with applicable statutes and accrediting bodies.

The role requires high-volume data entry, credentialing experience, and CPR certification. A team-oriented environment and standard business hours are provided, with a focus on accuracy and timely submissions.

Qualifications

• Must have at least a High School Diploma or GED.
• Two years of experience in the medical industry preferred. FQHC Experience preferred. Experience with multiple NPI numbers preferred.
• High Volume Data Entry Experience required.
• Credentialing experience required.
• CPR Certification required.

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.
• Work with providers to apply for and renew annually all provider licenses; Professional, DEA, Controlled Substance.
• Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid.
• Complete revalidation/re-credentialing requests issued by government and commercial payers.
• Credential/Privilege new providers and re-credential current providers within outpatient/ hospitals as needed.
• Work closely with the Chief Financial Officer and billing office to identify and resolve any denials or authorization issues related to provider credentialing.
• Maintain accurate provider profiles on credentialing and HRIS softwares.
• Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases

Skills

Credentialing

Data entry

NPI numbers

Attention to detail

Education

High School Diploma or GED

CPR Certification

Tools

CAQH

PECOS

NPPES

CMS databases

Job description

OVP Health is seeking a Credentialing Specialist to coordinate and monitor credentialing for outpatient providers and Recovery Center staff. You will maintain provider files, assist with license renewals, and ensure compliance with applicable statutes and accrediting bodies.

The role requires high-volume data entry, credentialing experience, and CPR certification. A team-oriented environment and standard business hours are provided, with a focus on accuracy and timely submissions.