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

Pay is based on factors such as market location, job-related knowledge, skills, and experience, and is benchmarked against similar organizations in our size and industry. It is not typical for an individual to be hired at or near the top of the posted range, as compensation decisions depend on the facts and circumstances of each case. In addition to cash pay, full-time regular employees are eligible for 401(k), health benefits, and other company-provided benefits; some of these benefits may also be available to part-time employees.

Credentialing Specialist Pay Range$20—$26 USD

About IVX Health

IVX Health is a national provider of infusion and injection therapy for individuals managing chronic conditions like Rheumatoid Arthritis, Crohn's Disease, and Multiple Sclerosis. We’re transforming the way care is delivered with a focus on patient comfort and convenience. Our commitment to exceptional care extends to our employees as well—we empower our team to thrive while living our core values: Be Kind, Do What’s Right, Never Settle, Make It Happen, and Enjoy the Ride.

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 teleme