Specialist, Internal Credentialing Auditing And Delegations Services

About Our Company

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.

Please Note: We will only contact candidates regarding your applications from one of the following domains: @summithealth.com, @citymd.net, @villagemd.com, @villagemedical.com, @westmedgroup.com, @starlingphysicians.com, or @bmctotalcare.com.

Job Description

The Internal Credentialing Auditing and Delegations Services Specialist assists in ensuring the accuracy, completeness and compliance of all credentialing records and processes according to the National Committee for Quality Assurance (NCQA), AAAHC, Health Plan Delegation Agreements, State and Federal Guidelines.

The role involves supporting the Manager and Senior Director with all delegated credentialing relationships and assisting with conducting audits of practitioner files to identify discrepancies. The specialist works closely with the Manager of National Credentialing Services to audit credentialing files and respond to delegated audit requests.

Essential Job functions:

• Supports delegated credentialing activities

• Assists with maintaining and credentialing processes and procedures

• Participates in credentialing delegation and internal audits to ensure compliance with health plan delegated agreements and follows-up with corrective action plan(s) if needed

• Audits credentialing files and system data to identify discrepancies as assigned by Manager or Senior Director.

• Communicate audit findings to the management for follow-up and re-education as needed

• Maintains a working knowledge of credentialing policies and procedures and regulatory requirements

Knowledge, Skills and Abilities Required:

• Ability to investigate and analyze information and draw conclusions.

• Ability to process computer data and to format and generate reports.

• Ability to communicate effectively, both orally and in writing.

• Ability to foster a cooperative work environment.

• Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community.

• Database management skills.

• Knowledge of related accreditation and certification requirements.

• Knowledge of medical credentialing and privileging procedures and standards.

• Knowledge of medical staff policies, regulations, and bylaws and the legal environment within which they operate.

General Job functions:

• Support Annual, monthly and quarterly reporting to all delegated health plans

• Internal auditing of practitioner files and system data

• Audits the provider database as well as other systems ensuring information is updated timely and the data is complete for each credentialed provider

• Participates in credentialing delegation and internal auditing to support the goals and initiatives for SHM and SMG

• Other job duties as required

Physical Job Requirements: Physical mobility - moving from place to place; dexterity of hands and fingers, endurance (continuous typing, prolonged standing, bending, walking); ability to lift/transport files when needed.

Education, Certification, Computer and Training Requirements:

Minimum of 5+ years of credentialing experience required, high school diploma or equivalent required, associate's degree preferred, Certified Provider Credentialing Specialist (CPCS) preferred, Certified Professional Medical Services Management preferred, Ability to communicate in English, both orally and in writing required, standard office equipment (phone, fax, copy machine, scanner, email, voicemail) required, standard office technology in a Window based environment required. Advanced Excel expertise is a plus. Experience with Cactus, Credential Stream or other credentialing software preferred. Must exhibit excellent internal and external customer service as well as possess the ability to properly handle sensitive and confidential information.

Travel - Yes, to clinical locations and business office locations, as necessary.

Work Location: Hybrid; may require in-office attendance based on the business' needs. Remote work from home may be allowed at the discretion of leadership.

This is an exempt position. The base compensation range for this role is $53,800 to $66,900 based on experience. 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.

About Our Commitment

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/.