Credentialing Specialist II

City/State Norfolk, VA Overview Work Shift First (Days) (United States of America) Sentara Health is seeking to hire a qualified individual to join our team as a Coding Credentialing Specialist II Position Status: Full-time, Day Shift Position Location: This position is remote for residents of VA (traveling flexibility is required). Standard Working Hours: 8:00AM to 5:00PM (ET). Position Summary: Under 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. Minimum Requirements: CPCS - Certified Provider Credentialing Specialist (Preferred) Requires thorough knowledge of managed care provider credentialing/re-credentialing principles, methods, regulations, and procedures normally acquired through a minimum of 2 years of directly related experience. Acceptable areas demonstrating experience would be direct work experience with organizations such as a CVO, MCO, HMO or Hospital Based Credentialing (MSO). High School Diploma required Associate Level Degree preferred Coding Certificate strongly preferred Diversity and Inclusion at Sentara Our vision is that everyone brings the strengths that come with diversity to work with them every day. When we are achieving our vision, we have team members that feel they belong and can be their authentic selves, and our workforce is reflective of the communities we serve. We are realizing this vision through our Diversity and Inclusion strategy, which has three pillars: A diverse and talented workforce, an inclusive and supportive workplace, and outreach and engagement with our community. We have made remarkable strides in these areas over the past several years and, as our world continues to evolve, we know our work is never done. Our strategies focus on both structural inclusion, which looks at our organizational structures, processes, and practices; as well as behavioral inclusion, which evaluates our mindsets, skillsets, and relationships. Together, these strategies are moving our organization forward in an environment that fosters a culture of mutual respect and belonging for all. Please visit the link below to learn more about Sentara’s commitment to diversity and inclusion: https://www.sentara.com/aboutus/mission-vision-and-values/diversity.aspx Sentara Overview For more than a decade, Modern Healthcare magazine has ranked Sentara Health as one of the nation's top integrated healthcare systems. That's because we are dedicated to growth, innovation, and patient safety at more than 300 sites of care in Virginia and northeastern North Carolina, including 12 acute care hospitals. Sentara Benefits As the third-largest employer in Virginia, Sentara Health was named by Forbes Magazine as one of America's best large employers. We offer a variety of amenities to our employees, including, but not limited to: Medical, Dental, and Vision Insurance Paid Annual Leave, Sick Leave Flexible Spending Accounts Retirement funds with matching contribution Supplemental insurance policies, including legal, Life Insurance and AD&D among others Work Perks program including discounted movie and theme park tickets among other great deals Opportunities for further advancement within our organization Sentara employees strive to make our communities healthier places to live. We're setting the standard for medical excellence within a vibrant, creative, and highly productive workplace. For information about our employee benefits, please visit: Benefits - Sentara (sentaracareers.com) Join our team! We are committed to quality healthcare, improving health every day, and provide the opportunity for training, development, and growth! Please Note: The yearly Flu Vaccination is required for employment. Note: Sentara Health offers employees comprehensive health care and retirement benefits designed with you and your family's well-being in mind. Our benefits packages are designed to change with you by meeting your needs now and anticipating what comes next. You have a variety of options for medical, dental and vision insurance, life insurance, disability, and voluntary benefits as well as Paid Time Off in the form of sick time, vacation time and paid parental leave. Team Members have the opportunity to earn an annual flat amount Bonus payment if established system and employee eligibility criteria is met. Job Summary Under 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. CPCS - Certified Provider Credentialing Specialist (Preferred) Requires thorough knowledge of managed care provider credentialing/re-credentialing principles, methods, regulations, and procedures normally acquired through a minimum of 2 years of directly related experience. Acceptable areas demonstrating experience would be direct work experience with organizations such as a CVO, MCO, HMO or Hospital Based Credentialing (MSO). Qualifications: ALD - Associate's Level Degree, HS - High School Grad or Equivalent (Required) Certified Provider Credentialing Specialist (CPCS) - Certification - Other/National Related Skills Active Listening, Communication, Judgment and Decision Making, Reading Comprehension, Speaking, Technology/Computer, Writing Sentara Healthcare 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. Per Clinical Laboratory Improvement Amendments (CLIA), some clinical environments require proof of education; these regulations are posted at ecfr.gov for further information. In an effort to expedite this verification requirement, we encourage you to upload your diploma or transcript at time of application. In support of our mission “to improve health every day,” this is a tobacco-free environment. Sentara Healthcare is a Virginia and Northeastern North Carolina based not-for-profit integrated healthcare provider that has been in business for over 131 years. Offering hundreds of sites of care including 12 hospitals, PACE, home health, hospice, medical groups, imaging services, therapy, outpatient surgery centers, and an 858,000 member health plan. The people of the communities that we serve have nominated Sentara “Employer of Choice” for over ten years. U.S. News and World Report has recognized Sentara as having the Best Hospitals for 15 years. Sentara offers professional development and a continued employment philosophy!