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Website: sentarahealth.com
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Sentara Health is hiring a Provider Credentialing Specialist II for our Campbell, Virginia office with the option to work from eligible locations across 30 states. This full-time position operates 8am–5pm EST, Monday through Friday, and plays a critical role in our managed care credentialing process. What This Role Involves As a Provider Credentialing Specialist II at Sentara Health, you'll manage the complete credentialing and re-credentialing lifecycle for providers in our network, working under the direction of a Credentialing Supervisor or Manager. Your work ensures compliance with National Committee for Quality Assurance standards, state regulations, and federal requirements. You'll verify credentials for medical, behavioral, facility, and ancillary providers, maintaining the integrity of our healthcare network. Core Duties Review and investigate primary source verifications for facility, medical, behavioral, and ancillary providers Process credentialing and re-credentialing applications according to NCQA, state, and federal standards Verify provider qualifications, licensure, certifications, and organizational affiliations Communicate with providers, medical schools, hospitals, and licensing boards to obtain documentation Maintain detailed records and track credentialing status through completion Identify and resolve discrepancies in provider information What We're Looking For High school diploma or GED (required) At least 2 years of direct experience in provider credentialing or re-credentialing (required) Working knowledge of managed care credentialing principles, regulations, and procedures Background working with a Credentials Verification Organization (CVO), managed care organization (MCO), HMO, or hospital-based credentialing department Proficiency with credentialing software such as Credential Stream, MDStaff, or Cactus (preferred) Certified Provider Credentialing Specialist (CPCS) certification (preferred) About the Company Sentara Health serves nearly one million members across Virginia through comprehensive health plans covering commercial products, individual and family coverage, employee assistance programs, and Medicare and Medicaid options. Our mission centers on improving health every day through coordinated clinical and behavioral health services, chronic disease management, and wellness initiatives. With a diverse workforce of nearly 30,000, we're committed to equity and inclusion as core values. The organization is an equal opportunity employer and maintains a tobacco-free workplace. Ready to Apply? Sentara Health offers competitive compensation—base pay ranging from $17.31 to $23.08 to $28.85 per hour for this full-time role, plus potential…
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