Position Summary / Scope of Responsibility
MedVanta is the nation's largest physician-owned and operated next generation management services organization (MSO). Our services are specifically designed for musculoskeletal (MSK) providers and go beyond that of a traditional MSO, empowering our clients with the precise infrastructure, data, technology, and administrative processes needed to thrive both today and tomorrow.
MedVanta has an employee centered culture that supports and promotes diversity and inclusion. Our encouraging and empowering management style makes MedVanta a great place to further grow your knowledge while building a team driven path to success.
The Credentialing Specialist provides administrative and verification assistance regarding licenses and credentials of medical staff members. Duties include keeping detailed records of medical staff members, maintaining databases, and ensuring medical staff possess legal licenses and credentials to continue work in their specialty.
Primary Responsibilities
The incumbent may be asked to perform job-related tasks other than those specifically stated in this description. The duties and responsibilities of the position are to be carried out in a manner that is consistent with the Mission, Core Values and Operating Principles of MedVanta.
1. Reviews and screens initial and reappointment credentialing applications for completeness, accuracy, and compliance with federal, state, local and MedVanta guidelines, policies, and standards.
2. Conducts primary source verification, collects, and validates documents to ensure accuracy of all credentialing elements; assesses completeness of information and qualification relative to credentialing standards and MedVanta criteria.
3. Identifies, analyzes, and resolves extraordinary information, discrepancies, time gaps, and other idiosyncrasies that could adversely impact ability to credential and enroll practitioners; discovers and conveys problems to Credentialing Manager.
4. Monitors files to ensure completeness and accuracy; reviews all file documentation for compliance with quality standards, accreditation requirements, and all other relevant policies.
5. Prepares and provides information to internal and external personnel and customers as appropriate.
6. Submits provider rosters to health plans with delegated status; ensures complete and accurate; follows-up with plans as necessary.
7. Enters, updates, and maintains data from provider applications into credentialing database, focusing on accuracy, and interpreting or adapting data to conform to defined data field uses.
8. Prepares, issues, tracks, and follows-up on appropriate verifications for efficient, high-volume processing of individual applications in accordance with applicable credentialing standards.
9. Works in EHR to research and resolve accounts pending credentialing action items; reports any concerns or challenges for potential escalation.
10. Performs other duties as aassigned.
Reporting Relationships
The Credentialing Manager reports directly to the assigned leader.The role does have direct reports.
Required Education and Experience
1.High school Diploma or GED
2. 3 years' professional experience within a managed care/healthcare environment, to include 2 years' experience involving the credentialing/recredentialing of healthcare providers.
3. Certified Provider Credentials Specialist (CPCS) or actively pursuing certification.
4. Extensive experience working in EMR/EHR systems, and credentialing software.
5. Expertise with standard MS office software and applications to manipulate, analyze, and interpret data.
6. Proven experience successfully innovating in a fast-growing work environment while dealing with ambiguity.
Competencies / Required Skills and Abilities
1. Strong Interpersonal, oral, and written communication skills with excellent self-discipline and patience between payors, providers, physicians, and colleagues.
2. Ability to work confidently and consistently in EMR systems and across multiple technological functions.
3. Confident, independent thinker and strong decision-making ability when circumstances warrant such action.
4. Demonstrated ability to organize, prioritize, and manage multiple tasks in a dynamic environment with a proven track record of results.
5. Ability to develop relationships and collaborate in a decentralized organization. Able to work independently as well.
6. Exudes professionalism in presentation.
7. Must be able to read, write, speak, understand, and communicate in the English language.
Physical Demands

1. Must be able to sit for long periods of time and lift up to 25 pounds.
2. Must be able to use appropriate body mechanics techniques when performing desk duties.
3. Requires frequent bending, reaching, repetitive hand movements, standing, walking, squatting, and sitting.
4. Adequate hearing to perform duties in person and over telephone.
5. Must be able to communicate clearly to patients in person and over the telephone.
6. Visual acuity adequate to perform job duties, including reading materials from printed sources and computer screens.