Credentialing Specialist

Overview

Technology Transforming Care Hudson Regional Health is a newly unified healthcare network serving Hudson County through four hospitals:
Secaucus University Hospital, Bayonne University Hospital, Hoboken University Hospital, and The Heights University Hospital in Jersey City.

Together, these hospitals form a single, integrated system with a shared vision—to deliver modern, patient-first care supported by innovation. From robotic-assisted surgery and AI-powered diagnostics to real-time monitoring and precision neurosurgery, HRH is redefining what's possible in community healthcare. Patients across the region now have access to state-of-the-art procedures and nationally recognized specialists, all within a connected, local network designed to put care first.

We focus on the care our patients need most, delivered with precision, innovation, and a commitment to excellence.

• Advanced Emergency Services – 24/7 emergency departments across all four hospitals
• Robotic-Assisted Surgery – featuring the Da Vinci XI and Excelsius
  
  GPS systems
• Neurosurgery & Spine Care – including Stealth Navigation and precision-guided treatment
• Women's Health & Maternity – comprehensive services tailored for every stage
• Imaging & Diagnostics – AI-enhanced systems for faster, more accurate results
• Outpatient & Specialty Care – coordinated care across multiple disciplines

Explore our hospitals and discover care that's high-tech, high-touch, and close to home:

• Secaucus University Hospital, Flagship campus featuring the Robotic Surgery Institute and modernized emergency care.
• Bayonne University Hospital, A full-service community hospital offering personalized acute care.
• Hoboken University Hospital, A local leader in women's health, family medicine, and outpatient services.
• The Heights University Hospital (Jersey City), Expanding access to state-of-the-art care in the heart of Jersey City.

The successful candidate will be able to:

Under the supervision of the MSO Manager of the area, responsible for credentialing and recredentialing practitioners as well as enrollment with participating client health plans. Credentialing functions include, but are not limited to, processing credentialing applications, following up with payers, and updating and maintaining the CAQH data base, as well as following applicable state and federal requirements for Medicare and Medicaid.

• Leads, coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility.
• Conducts thorough background investigation, research and primary source verification of all components of the application file.
• Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.
• Prepares credentials file for completion other healthcare organizations, ensuring file completion within time periods specified.
• Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing issues as they arise.
• Utilizes the Cactus credentialing database, optimizing efficiency, and performs query, report and document generation; submits and retrieves National Practitioner Database reports in accordance with Health Care Quality Improvement Act.
• Monitors the initial, reappointment and expirable process for all medical staff, Allied Health Professional staff, Other Health Professional staff, and delegated providers, ensuring compliance with regulatory bodies (Joint Commission, NCQA, URAC, CMS, federal and state), as well as Medical Staff Bylaws, Rules and Regulations, policies and procedures, and delegated contracts.
• Performs miscellaneous job-related duties as assigned.

• Degree in business or health related field desired. Previous experience in a Credentialing position required.
• CPMSM and/or CPCS Certification by the National Association Medical Staff Services required or obtained within two years of employment.
• Affiliation with the National Association Medical Staff Services and the State Association Medical Staff Services strongly encouraged.
• Must…