Medical Staff Services Specialist

Summary

Join Valera Health, a leader in tele-mental health, as a Medical Staff Services Specialist! This role ensures swift and accurate operations for provider onboarding, credentialing, and regulatory compliance. You will guide new providers through onboarding, manage documentation, verify eligibility, maintain credentialing files, and process applications. The position requires adherence to NCQA and regulatory standards, database maintenance, and monitoring of license expirations. You will also assist in training new team members and maintain strict confidentiality. Valera Health offers competitive pay and a range of employee benefits.

Requirements

• 1-2 years of credentialing experience
• Have worked in a remote setting before

Responsibilities

• Meet with newly onboarded providers to guide them through onboarding requirements and ensure timely completion
• Manage and review onboarding documentation and enter provider data into the provider platform
• Verify provider eligibility for working in specific states and health plans
• Maintain ongoing CAQH management and provider credentialing files
• Process initial and reappointment credentialing applications, including primary source verification and deficiency resolution, in accordance with NCQA and regulatory standards
• Prepare and submit credentialing and recredentialing reports and delegated rosters to health plans
• Maintain the Medical Staff electronic database and track all credentialing verifications
• Monitor and notify providers of upcoming license expirations and required renewals
• Maintain CMS I&A requests and approvals
• Ensure full compliance with NCQA, CMS, HIPAA, and all applicable state and federal regulations
• Notify appropriate staff when providers are fully onboarded and credentialed
• Assist in training new team members
• Maintain strict confidentiality of all provider information
• Perform other duties as assigned
• Ensure strict HIPAA-compliant confidentiality with all healthcare-related data
• Set up and manage provider information in the provider data platform
• Resolves any deficiencies with credentialing or licensing in compliance with regulatory requirements
• Processes applications (initial and reappointment) for credentials for Valera providers by obtaining and analyzing primary source verification information and identifying deficiencies in records as outlined in the bylaws in accordance with credentialing requirements of NCQA
• Establishes, updates, and maintains credentialing files for every provider in employment. Ensures compliance with state, federal, and accrediting agency requirements
• Maintains the Medical Staff electronic database. Second set of eyes for all verification, tracking, and maintenance
• Maintains CMS I&A requests and approvals
• Assist with completing delegated health plan monthly rosters
• Assist in training new team members

Benefits

• Health, Vision & Dental Insurance
• 401k through the Standard
• Paid Time Off
• Short Term Disability
• Life Insurance
• Office Equipment