Credentialing Specialist Administration

Credentialing Specialist I (3007) - Administration

Apply for the Credentialing Specialist I (3007) - Administration role at Tidewater Physicians Multispecialty Group.

Tidewater Physicians Multispecialty Group is actively seeking a Credentialing Specialist I to practice out of our Administration office in Newport News. TPMG includes more than 220 primary care, specialty physicians and advanced practice clinicians in more than 75 locations throughout southeastern Virginia.

Prior experience in provider credentialing is preferred. The core hours are Monday through Friday 8:30 a.m. – 5:00 p.m.

The successful candidate must possess strong critical thinking skills, be thorough and accurate in their work processes, be organized and efficient, and have attention to detail.

Interested candidates are invited to submit their application. Come join the team!

As a Credentialing Specialist I, you must research, compile and maintain reports that detail medical staff accreditation, organizational membership and adherence to facility policies. This includes fact‑checking with various certification boards and agencies. All information must be entered into a secure online database and updated regularly. The database should include each medical provider’s DEA certificates, state licenses and malpractice insurance coverage.

You will also regularly complete and submit staff credentialing or re‑credentialing applications to the appropriate agencies and track when certifications are due to expire. In some cases, you might even be tasked with overseeing the auditing of a facility or individual practitioner. Therefore, staying current on state and federal regulatory requirements is vital to the effective execution of your duties.

• Compiles and maintains current and accurate data for all providers. Database management of One App Pro software and CAQH, NPPES and VBOM.
• Compiles and maintains current and accurate data for all providers. Database management of One App Pro software and CAQH, NPPES and NPDB, OIG, SAM and VBOM complaint management for all specialties and provider enrollment.
• Working knowledge of provider credentialing and re‑credentialing applications; monitors applications and follows‑up as needed.
• Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
• Maintains corporate provider contract files with varied payers.
• Working knowledge of hospital credentialing to include initial and reappointments. Coordinates and provides administrative support with initial credentialing and privilege delineation activities in accordance with medical staff policies, bylaws, and regulations so as to ensure that only qualified practitioners provide care at this hospital.
• Initiates information collection, verification, and documentation processes for completed applications per established hospital medical staff office policies and procedures.
• When applicable and in accordance with medical staff bylaws, policies, and procedures, notifies all appropriate parties of any action taken.
• Maintains knowledge of current malpractice requirements for credentialing providers.
• Ensures practice addresses are current with health plans, agencies and other entities.
• Processes applications for appointment and reappointment of privileges.
• Audits health plan directories for current and accurate provider information. Updates payer with current provider information.
• Handles correspondence with providers including updates, mailings of applications, completed executed agreements.
• Tracks & submits licensure renewal requests, and ensures that all provider’s licenses are current.
• Prepares accurate and timely reports for clients and internal staff.
• Processes all applications for credentialing, re‑credentialing, initial appointments, and re‑appointments for medical license and DEA certificates.
• Responds to medical staff office requests in a timely manner.
• Maintains CAQH online applications for providers as well as NPPES database.
• Maintains and applies for new NPI information.
• Notifies Central Billing Office Manager with instructions for new…