Credentialing Coordinator Sr

Blue Ridge Cancer Care is searching for a Credentialing Coordinator Sr. to join our growing team in Blacksburg, Virginia. We have been providing community-based cancer care in Blacksburg and the surrounding communities for over 50 years. With multiple locations, a team of over 50 providers, and a partnership with The US Oncology Network, Blue Ridge Cancer Care is a great place to grow in your career.

The Credentialing Coordinator is a Monday through Friday (8:AM - 5:00PM) position with no weekend or holiday hours. This position can be hybrid and/or fully remote. Blue Ridge Cancer Care offers comprehensive benefits including health, 401(k), and a great team environment.

• With limited supervision performs all tasks related to credentialing and re-credentials providers according to quality standards and company policies and procedures.
• Handles all payor enrollment and credentialing information in a strictly confidential manner.
• Supports providers through active communication of licensure expirations. Submits licensure applications and renewal forms with payment to State agencies and appropriate departments. Recommend process improvements.
• Processes all enrollment related tasks, including Faculty and Physician enrollment, hospital credentialing or re-credentialing applications, review of applications and other data for accuracy and completeness; preparation and distribution of correspondence such as requests for information, verification letters, and verification of licensure/certifications.
• Maintains current provider licensure files in accurate and organized manner and enters, tracks, and updates provider payor, hospital information in the database; and provides information to hospitals and other healthcare providers as appropriate.
• Verifies initial and re-verifies existing credential statuses for reappointment, medical licensure, federal DEA registration, board certification, and malpractice insurance coverage, for facilities and physicians.
• Requests and completes hospital credentialing and privileges applications for providers.
• Obtains malpractice insurance for providers as necessary.
• Obtains and maintains provider participation in managed care plans in a timely manner and communicates information to practice sites and business office.
• Notifies government, payor, and managed care plans of physician terminations or transfers in a timely manner.
• Assists in providing documentation for Peer Review.
• Supports Network Contracting Representative/Manager in general administrative functions.
• Trains junior and practice staff with respect to credentialing contracts, policies and procedures.
• Other duties as requested or assigned.

Education

• High School diploma or equivalent required. Technical certification or associate's degree a plus. At least five (5) years of credential-related work experience required.
• Proficiency with computer systems and MicroSoft (Office Outlook, Word, Power Point, and Excel) required.

Certification/Licensure

• CPCS - Certified Provider Credentialing Specialist (Preferred, but not required)

Job Qualifications & Competencies

Requires thorough knowledge of managed care provider credentialing/re-credentialing principles, methods, regulations, and procedures normally acquired through a minimum of 5 years of directly related experience. Acceptable areas demonstrating experience would be direct work experience with organizations such as a CVO, MCO, HMO or Hospital Based Credentialing (MSO).

COMPETENCIES:

• Technical and Functional Experience: Possesses up to date knowledge of the profession and industry; is regarded as an expert in the technical/functional area; accesses and uses other expert resources when appropriate.
• Demonstrates Adaptability: Handles Day to day work challenges confidently; is willing and able to adjust to multiple demands, shifting priorities, ambiguity and rapid change; shows resilience in the face of constraints, frustrations, or adversity; demonstrates flexibility.
• Uses Sound Judgment: Makes timely, cost effective and sound decisions; makes decisions under conditions of uncertainty.
• Shows Work Commitment: Sets high standards of performance; pursues aggressive goals and works efficiently to achieve them with minimal assistance.
• Commitment to Quality: Emphasizes the need to deliver quality products and/or services; defines standards for quality and evaluates products, processes, and service against those standards; manages quality; improves efficiency while requiring minimal supervision.

PHYSICAL DEMANDS:

This position is primarily sedentary and requires the ability to remain seated at a desk for extended periods while working on a computer. The role involves frequent use of hands and fingers for typing and handling documents, as well as occasional standing, walking, and reaching. The employee must be able to communicate effectively, both verbally and in writing. Light lifting of office materials (up to 10 pounds) may be required.