Newport News, Virginia Hiring Range $21.30 - $27.68/Hourly Actual pay is determined based on job-related factors such as relevant experience, education, credentials, skills, internal equity, and business needs. Overview Functions as the primary liaison for all aspects of the onboarding process and Riverside Medical Group. Verifies credential documents (VA Medical License, Federal DEA, Board Certification and Visas), credentials and recredentials healthcare providers with contracted payors, reviews applications, monitors quality data and all applicable functions within the directive of quality control in the organization. Reports to the management staff at the organization and relies on instruction and pre-defined guidelines to perform various functions of the job, typically entering all information regarding providers into a database system of record. Recommends best practice or commonly used processes for quality improvement in credentialing. What you will do Accurately complete and maintain the following Provider applications (both Initial and Re-credentialing/Renewals) as required (completion of applications includes conducting any necessary follow-up to ensure timely completion of process). Ensure timely Provider Onboarding to mitigate access issues for patients which helps to drive financial growth. Responsible for timely release of pending claims for newly credentialed providers to ensure financial stability for the Medical Group. Accurately builds, updates and maintains provider information electronically in all appropriate databases (Credentialing Database, CAQH, Echo, NPI, EMR/HER and patient accounting system) to ensure data integrity. Maintain accurate information in internal and external directories per CMS and other regulatory guidelines. Investigates problems related to credentialing, including but not limited to, payor participation status, supervising/collaborating physician agreements, billing, invalid place of service, CLIA and NPI denials issues. Responds within 2 business days. Researches legal sanctions regarding licensure to ensure compliance with Federal and State regulations. Finds and reports all issues prior to malpractice submission or upon discovery. Qualifications Education High School Diploma or GED, (Required) Experience 2 years Active experience in credentialing/privileging (Required) in iCare/EPIC (Required) Licenses and Certifications Certified Provider Credentialing Specialist (CPCS) (Preferred) To learn more about being a team member with Riverside Health System visit us at https://www.riversideonline.com/careers. If loving your work is important to you, consider a career at Riverside. By joining our team, you can make a difference in people's lives. Our mission is to care for others as we would care for those we love. We extend that sense of caring to every patient, resident and customer, as well as to each member of our team. We offer care at all stages of life, in hundreds of locations, giving you room to grow your career, along with great benefits and perks. At Riverside Health, your trust and safety are our top priorities. Unfortunately, job scams are on the rise across the country, and we want to help you feel confident in knowing what is — and is not — part of our hiring process. Learn more about how to recognize a legitimate Riverside job opportunity and what to do if you suspect a scam by visiting this site.

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