Job Description

Advantia is transforming healthcare for all women – we're setting a higher standard of care and convenience while reducing unnecessary costs. Compassion and value inspire everything we do. We take time to listen, answer questions completely, and offer helpful technology between visits so that our patients are empowered and at ease. Alongside coordinated care, Advantia is pioneering care models that align incentives with the best interests of women and their families.

Advantia is expanding quickly through organic growth and acquisitions, providing direct care through more than 200 providers across over 50 Ob-Gyn and coordinated specialist offices. Advantia also enables health plans, state health organizations, hospital systems, and employers to deliver high-value care through technology products including its Pacify perinatal app.

The Credentialing Specialist reports to the Vice President of Payor Relations and is responsible for maintaining accuracy of clinicians information, submitting initial and re-credentialing applications to hospitals and payors, as well as maintaining licensing and certification renewals. 

Job Responsibilities:

• Maintain individual clinician files to include up to date information needed to complete the required
• governmental and commercial payer credentialing applications
• Apply for and renew annually all clinician licenses; Professional, DEA, Controlled Substance
• Complete revalidation requests issued by government payers
• Complete credentialing and re-credentialing applications to add clinicians to commercial payers, Medicare, and Medicaid
• Maintain accurate clinician profiles on CAQH, PECOS, NPPES, and CMS databases
• Responsible for initial and renewal applications for clinicians with hospitals at which they hold staff privileges
• Serve as support for the billing department regarding any claim issues that involve credentialing or clinicians.

Job Requirements:

• High school diploma or GED is required 
• 3+ years of experience in healthcare credentialing
• Knowledge of medical clinician credentialing and accreditation principles, policies, processes, procedures, and documentation.
• Working knowledge of clinical and/or hospital operations and procedures.
• Ability to use independent judgment and to manage and impart confidential information.
• Ability to maintain confidentiality and discretion in all communications on behalf of credentialing applicants and/or applications.
• Ability to make administrative/procedural decisions and judgments.

Benefits:

• Competitive Compensation
• Health, Dental, and Vision Insurance
• Health Savings Account (HSA) and Flexible Savings Account (FSA) Option
• 401k Retirement Plan
• Life and Disability Insurances
• Paid holidays/PTO

Please note:  Advantia Health is dedicated to providing unparalleled healthcare to our customers by employing the most highly-qualified individuals. If you are selected for further consideration, you will be subject to a background investigation. C OVID-19 and Flu vaccination or an approved request for accommodation is required as a condition of employment.

Advantia Health is an Equal Opportunity Employer that is committed to global diversity: It is a place where good people want to work, and customers want to continue to engage in EOE M/F/D/V.

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