Provider Credentialing Specialist II - Remote!

Sentara Workforce Solutions, LLC; Raleigh (NC); Remote; USD 24,000 - 40,000; Full time

Benefits offered by this job

Medical, Dental, Vision plans

Tuition Assistance

Paid Time Off

Job summary

Sentara Health Plan is hiring a Provider Credentialing Specialist II - Remote. The role performs credentialing and re-credentialing processing for a managed care organization, ensuring compliance with NCQA and state/federal regulations.

Remote opportunities are available in multiple states. The position requires a minimum of 2 years of directly related credentialing experience and offers 40 hours weekly, typically 8am–5pm EST, Monday–Friday.

Qualifications

• Minimum of 2 years of directly related credentialing experience REQUIRED.
• Thorough knowledge of managed care credentialing/re-credentialing principles, methods, regulations, and procedures.

Responsibilities

• Review, investigate, and process primary source verifications for facility, ancillary, medical and behavioral providers in a timely, efficient manner.
• Assist with credentialing and re-credentialing processing under supervision of a Credentialing Supervisor/Manager.
• Ensure compliance with NCQA, state and federal regulations.

Skills

Credentialing knowledge

Credentialing experience

CPCS certification

Education

High school diploma or equivalent

Tools

Credential Stream

MDStaff

Cactus

Job description

City/StateNorfolk, VAWork ShiftFirst (Days)Overview:Sentara Health Plan is currently hiring a Provider Credentialing Specialist II - Remote!Status: Full-time, permanent position (40 hours)Work hours: 8am to 5pm EST, M-FLocation: Remote opportunities available in the following states: Virginia, North Carolina, Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington (state), West Virginia, Wisconsin, WyomingJob ResponsibilitiesUnder the supervision of a Credentialing Supervisor/Manager, the Credentialing Specialist II is responsible for specific aspects of Credentialing and Re-credentialing processing for a managed care organization, adhering to the National Committee for Quality Assurance, State and Federal regulations. They review, investigate, and process primary source verifications for facility, ancillary, medical and behavioral providers in a timely, efficient manner.Education:HS - High School Grad or Equivalent REQUIREDCertification/License:None requiredExperience:Minimum of 2 years of directly related experience REQUIRED;With thorough knowledge of managed care provider credentialing/re-credentialing principles, methods, regulations, and procedures normally acquired through a. Acceptable areas demonstrating experience would be direct work experience with organizations such as a Credentials Verification Organization (CVO), MCO, HMO or Hospital Based Credentialing (MSO).CPCS - Certified Provider Credentialing Specialist preferredExperience in using Credential Stream is a plus or other similar programs like MDStaff or Cactus preferredPay Transparency:We provide market-competitive compensation packages, inclusive of base pay, incentives, and benefits. The base pay rate for Full Time employment is: $17.31 - 23.08 - 28.85. Additional compensation may be available for this role such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities."Sentara Health Plans provides health plan coverage to close to one million members in Virginia. We offer a full suite of commercial products including employee-owned and employer-sponsored plans, as well as Individual & Family Health Plans, Employee Assistance Programs and plans serving Medicare and Medicaid enrollees.Our quality provider network features a robust provider network, including specialists, primary care physicians and hospitals.We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services—all to help our members improve their health.Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth.Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!To apply, please go to www.sentaracareers.com and use the following as your Keyword Search: JR-104768Talroo-Health PlanKeywords: Healthcare, Health Plan, Remote, Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington (state), West Virginia, Wisconsin, Wyoming, Credentials Verification Organization (CVO), MCO, Managed Care, HMO, Hospital Based Credentialing (MSO), CPCS, Certified Provider Credentialing SpecialistBenefits: Caring For Your Family and Your Career• Medical, Dental, Vision plans• Adoption, Fertility and Surrogacy Reimbursement up to $10,000• Paid Time Off and Sick Leave• Paid Parental & Family Caregiver Leave• Emergency Backup Care• Long-Term, Short-Term Disability, and Critical Illness plans• Life Insurance• 401k/403B with Employer Match• Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education• Student Debt Pay Down – $10,000•Pet Insurance•Legal Resources Plan•Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.In support of our mission “to improve health every day,” this is a tobacco-free environment.For positions that are available as remote work, Sentara Health employs associates in the following states:Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.