Senior Credentialing Specialist at VillageMD
Join VillageMD as a Senior Credentialing Specialist in Houston, TX
Join the frontlines of today's healthcare transformation
At VillageMD, we're looking for a Senior Credentialing Specialist to help us transform the way primary care is delivered and how patients are served. As a national leader on the forefront of healthcare, we've partnered with many of today's best primary care physicians. We're equipping them with the latest digital tools. Empowering them with proven strategies and support. Inspiring them with better practices and consistent results.
We are creating care that's more accessible. Effective. Efficient. With solutions that are value-based, physician-driven and patient-centered. To accomplish this, we're looking for individuals who share our sense of excellence, are ready to embrace change, and never settle for the status quo. Individuals who have the confidence to lead but the humility to never stop learning.
Could this be you?
Integral to our team, you’ll be responsible for all aspects of the payer credentialing, re-credentialing and privileging processes for launching all providers. In this role, the Senior Credentialing Specialist is a key liaison between the providers, the payers, and VillageMD.
How you can make a difference
- Obtain pertinent data from providers to initiate the credentialing process
- Perform quality review audits of credentialing files
- Maintain up to date data for each provider in databases
- Track provider licenses, certifications, and professional liability insurances to ensure timely renewals.
- Contact person for CVO when additional information in needed
- Review files from CVO for completion
- Present files to Medical Director or Credentialing Committee as required
- Maintains delegate files in accordance with the standards set forth by internal policies and procedures and external regulatory requirements
- Coordinates with all delegates to ensure timely and accurate receipt and transmission of additions, terms and changes to network physician information
- Performs annual delegation audits as well as pre-delegation assessments, including policy and procedure review and file review to ensure regulatory compliance
- Engage in development, communication and follow-up for corrective action plans for delegated providers
- Interact with internal departments, varied levels of management, physicians, and physician’s office staff effectively to accomplish credentialing timelines
- Meet or exceed departmental timeframes and quality metrics on a consistent basis
- Perform all other related duties as assigned
Skills for success
- A willingness to learn, take initiative and be resourceful
- A bias for action and pragmatic solutions
- Detail and results-oriented, ability to manage and prioritize requests, and effectively communicate
- The ability to be flexible in an ambiguous and dynamic environment
- Ability to solve problems, and establish trust
- A low ego and humility; an ability to gain trust through strong communication and doing what you say you will do
- Strong desire to learn and grow within a fast-growing company
Experience to drive change
- 3+ years of experience in managed care credentialing, provider enrollment and/or Medical Staff service setting, specifically working with health plans.
- Knowledge of NCQA and CMS regulatory requirements
- Experience managing CAQH Provider Profiles
- Demonstrated skills in problem solving, analysis and resolution
- Must be able to function independently, possess demonstrated flexibility in multiple project management
- Must comply with HIPAA rules and regulations
- Demonstrated, extensive knowledge of third-party and insurance company operating procedures, regulations and billing requirements, and government reimbursement programs
- Working knowledge of payer credentialing rules and regulations
- Extensive knowledge and experience with Medicare and Medicaid provider enrollment applications and processes
- Deep understanding of how physician payer enrollment affects the revenue cycle
How you will thrive
In addition to competitive salaries, a 401k program with company match, bonus and a valuable health benefits package, VillageMD offers paid parental leave, pre-tax savings on commuter expenses, and generous paid time off. You work in a highly-collaborative, conscientious, forward-thinking environment that welcomes your experience and enables you to make a significant impact from Day 1.
Most importantly, you make a difference. You see a clear connection between your daily work on VillageMD products and services and the advancement of innovative solutions and improved quality of healthcare for providers and patients.
Our unique VillageMD culture – how inclusion and diversity make the difference
At VillageMD, we see diversity and inclusion as a source of strength in transforming healthcare. We believe building trust and innovation are best achieved through diverse perspectives. To us, acceptance and respect are rooted in an understanding that people do not experience things in the same way, including our healthcare system. Individuals seeking employment at VillageMD are considered without regard to race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
Explore your future with VillageMD today