Credentialing Specialist

We’re a physician-led, patient-centric network committed to simplifying health care and bringing a more connected kind of care.

Our primary, multispecialty, and urgent care providers serve millions of patients in traditional practices, patients' homes and virtually through VillageMD and our operating companies Village Medical, Village Medical at Home, Summit Health, CityMD, and Starling Physicians.

When you join our team, you become part of a compassionate community of people who work hard every day to make health care better for all. We are innovating value-based care and leveraging integrated applications, population insights and staffing expertise to ensure all patients have access to high-quality, connected care services that provide better outcomes at a reduced total cost of care.

At VillageMD, we're looking for a 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

• 5+ 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

This is a non-exempt position. The base compensation range for this role is $22.00/hr - $25.00/hr.  At VillageMD, compensation is based on several factors including but not limited to education, work experience, certifications, location, etc.  The selected candidate will be eligible for a valuable company benefits plan, including health insurance, dental insurance, life insurance, and access to a 401k plan

Total Rewards at VillageMD

Our team members are essential to our mission to reshape healthcare through the power of connection. VillageMD highly values the critical role that health and wellness play in the lives of our team members and their families.  Participation in VillageMD’s benefit platform includes Medical, Dental, Life, Disability, Vision, FSA coverages and a 401k savings plan.

Equal Opportunity Employer

Our Company provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to, and does not discriminate on the basis of, race, color, religion, creed, gender/sex, sexual orientation, gender identity and expression (including transgender status), national origin, ancestry, citizenship status, age, disability, genetic information, marital status, pregnancy, military status, veteran status, or any other characteristic protected by applicable federal, state, and local laws.

Safety Disclaimer

Our Company cares about the safety of our employees and applicants. Our Company does not use chat rooms for job searches or communications. Our Company will never request personal information via informal chat platforms or unsecure email. Our Company will never ask for money or an exchange of money, banking or other personal information prior to the in-person interview. Be aware of potential scams while job seeking. Interviews are conducted at select Our Company locations during regular business hours only. For information on job scams, visit, https://www.consumer.ftc.gov/JobScams or file a complaint at https://www.ftccomplaintassistant.gov/.