Credentialing Specialist

About the role

The Credentialing Specialist is responsible for credentialing, enrollment of practitioners reporting for all states and jurisdictions in IVX Health operates. The Credentialing Specialist prepares, tracks, and submits licensure, certification and credentialing applications to various government and commercial payor offices. The Credentialing Specialist is responsible for maintaining active status for all providers by successfully completing initial and subsequent credentialing packages as required by commercial payers, Medicare, and Medicaid.

Responsibilities

• Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications
• Credential new providers and re-credential current providers with clinics at which they hold staff privileges
• Responsible for facilitating the completion of all payer practitioner linking applications
• Manage and maintain contracts, licenses and credentials for all current providers
• Perform regular communication with payers including but not limited to receiving quarterly fee schedules, updates, and any additional relevant documentation
• Develop, implement, and monitor processes and procedures to ensure the consistent delivery of quality contracting and credentialing services in an efficient and cost-effective manner
• Ensure that the credentialing program is compliant with health plans, as well as State and Federal regulations including Medicare, Joint Commission, IMQ, AAAHC and other accrediting bodies
• Track enrollment status with each required organization, agency, affiliate, and third-party payer
• Maintain accurate provider profiles on CAQH, PECOS, and CMS databases
• Maintain databases for all active provider files to include Verity and Availity
• Credential new providers and re-credential current providers with clinics at which they hold staff privileges
• ESSENTIAL COMPETENCIES
• Exceptional written and verbal communication skills, with a proven ability to interact effectively with a variety of external and internal constituents
• Strong analytical and problem-solving skills
• Ability to recognize and resolve ambiguous or conflicting objectives
• Knowledge of provider credentialing and its direct impact on the practices revenue cycle
• Proficiency with standard office software applications (Microsoft Office, Outlook, Teams, etc.)
• REQUIRED EDUCATION & EXPERIENCE
• Bachelors degree or equivalent work experience
• 3-5 years experience and demonstrated success in provider and facility contracting and credentialing with commercial and government payers
• Certified Provider Credentialing Specialist (CPCS) certification preferred
• Demonstrated experience in working with multi-site and/or multi-state providers
• Experience with Infusion, G/I, Rheum, Neuro and/or large distributed medical practices desired
• Credentialing Specialist Pay Range
• $20 - $26 USD
• About IVX Health
• Our Mission: To improve the lives of those we care for by redefining the care experience
• Our Vision: To be the nation's preferred destination for pharmaceutical care of complex chronic conditions
• Our Commitment: To deliver an unmatched care experience with a foundation in world class service and clinical excellence
• Benefits We Offer
• Comprehensive Healthcare - Medical, dental, and vision coverage, including prescription drug plans and telemedicine services.
• Flexible Savings Options - Choose from Health Savings Accounts (HSA) and Health Reimbursement Arrangements (HRA) to manage healthcare costs.
• Supplemental Protection - Accident, critical illness, and hospital indemnity plans to provide additional financial security.
• Dependent Care FSA - Pre-tax savings for eligible childcare and dependent care expenses.
• 401(k) Retirement Plan - Secure your future with a competitive company match.
• Disability Coverage - Voluntary short-term and long-term disability plans to protect your income.
• Fertility and Family Support - Resources and benefits designed to support fertility care and family p

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