Credentialing Coordinator

Virginia Oncology Associates, the largest group of medical professionals in Hampton Roads and Northeast North Carolina devoted exclusively to cancer care and blood disorders, has an exciting opportunity for a Credentialing Managed Care Coordinator for our office in Norfolk.

***Please take this quick survey once you've submitted your resume to complete the application process: Credential and Managed Care PI Survey

****If you have completed the survey before, please do not take it again.

• Credentials and re-credentials providers according to quality standards and company policies and procedures. Notifies providers of licensure expirations and submits licensure applications and renewal forms with payment to State agencies and appropriate departments. Recommends process improvements.
• Maintains current provider licensure files and provides information to hospitals and other healthcare providers as appropriate. Requests and completes hospital credentialing and privileges applications for providers.
• Obtains and maintains provider participation in managed care plans in a timely manner and communicates information to practice sites and business office.
• May implement and maintain the contract management system to include terms of the contract, providers credentialed to the payer and other contracted service providers (labs, hospitals).
• May complete EOB analyses or fee schedule variance reporting on a monthly basis for the top Managed Care payers according to policy and procedure. May produce monthly managed care reports and implement new analysis tools to assist in reporting functions.
• May maintain expected reimbursement by CPT code for the top payer contracts in each market and communicate changes to system librarian.
• May develop and provide maintenance of proformas for all contracts.
• 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.

• High school diploma or equivalent required.
• Technical certification or Associates Degree a plus.
• At least five (5) years of credentialing related work experience required.
• Proficiency with computer systems and Microsoft (Office Outlook, Word, Power Point, and Excel) required.
• CPCS certification is preferred.

PHYSICAL DEMANDS:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Requires sitting for long periods of time. Some bending and stretching required. Adequate finger dexterity and feeling to perform keyboarding and substantial repetitive motions involving the wrists, hands and/or fingers. Requires corrected vision and hearing to normal range. Must be able to view computer screen and printed material accurately. Occasionally lifts and carries items weighing up to 40 lbs.

WORK ENVIRONMENT:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The work environment is typical of an office setting. Requires occasional travel by automobile.