Credentialing Specialist
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Job Description
Credentialing Specialist managing provider credentialing, enrollment, licenses, and healthcare databases for Ivy Health. Fully remote role supporting health plans, CVOs, and external vendors.
Responsibilities:
- Maintain current and accurate data for all providers.
- Complete provider/payor enrollment applications, monitor applications and follow up as needed.
- Maintain copies of current state licenses, malpractice coverage and other required provider documents.
- Maintain provider information in online databases such as NPI and CAQH.
- Collect information from providers and coordinate with the CVO to submit credentialing requests.
- Track license and certification expirations to ensure timely renewals.
- Audit and ensure practice address information with health plans is listed correctly.
- Maintain confidentiality of provider information.
- Perform other duties as assigned.
Requirements:
- A high school diploma or GED equivalent is required.
- Certified Provider Credentialing Specialists (CPCS) certification preferred, but not required.
- A minimum of two years of experience in all facets of provider healthcare credentialing, with a focus on Outpatient PT/OT/SP/ABA/Pediatric Rehab.
- Computer skills using Microsoft Outlook, Word, Excel and Access.
- Experience using credentialing software and working with a CVO and external vendors.
- Excellent oral communication skills and phone presence.
- Understanding of quality customer service and relationship with insurance carriers and field operators.
- Knowledge of health plans and other state agency requirements for credentialing.
- Ability to research and analyze data.
- Ability to work independently with minimal supervision.
- Ability to maintain confidentiality of provider information.
Benefits:
- Eligibility for full benefits package beginning within your first month of employment
- Generous PTO (Paid Time Off) plans
- Paid holidays
- Medical, dental, vision insurance
- 401k with company matching contribution
- Disability & life insurance
- Pet insurance discounts
- Paid parental leave and maternity leave
- Gym and wellness discounts
- Free mental health + financial services
- Generous PTO Program
- 6 paid holidays annually
- Bonus eligibility
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