Credentialing Specialist

This role is an exempt on-site role, located at our New Providence CBO location.

Compensation Range: $37,336.00 - $77,542.40 (Dependent on Experience)

The Credentialing Specialist reports to the Credentialing Manager and is responsible for timely submission and follow-up of medical payer enrollment applications, and credentialing applications for appointment and re-appointment to hospitals and Ambulatory Surgery Centers (ASCs).

Responsibilities:

Add, update and maintain accurate provider information in CAQH, Credential Stream and other tools commonly utilized for credentialing and payer enrollment.

Work closely with providers, internal departments and other team members to obtain necessary information for timely onboarding.

Initiate Credentialing Onboarding activities with new providers joining the organization.

Provide information and resources to providers related to changes and CME requirements for state and federal licenses and registrations renewals.

Complete, submit, document and proactively track and follow-up on required licensing, credentialing and enrollment applications, paying close attention to details.

Gather, compile and continuously monitor information necessary for licensing, enrollment and credentialing purposes.

Update and inform department and other leadership of progress and issues using various means of communication.

Research and respond to internal and external inquiries related to enrollment and credentialing issues.

Maintain working knowledge of applicable regulations, policies and procedures and understand specific application requirements for provider licensing, credentialing applications and payer enrollment submission.

Conduct audits and quality assurance checks to verify the accuracy and completeness of provider and organization data in credentialing system, working with other departments to obtain when needed.

Attend applicable payer webinars and other educational events, monitor payer enrollment updates, communicate and update team and other departments of upcoming changes.

Work collaboratively in a team environment to achieve team and organizational goals, sharing information, resources and implementing process improvements. Encourage and facilitate cooperation and trust, building team spirit and strong relationships.

Maintain a high level of confidentiality regarding legal matters, privacy issues and data integrity.

Other duties as assigned.

Aids with ad-hoc, special projects, as needed.

Qualifications:

Education:

Bachelor's degree in business or relevant area.

Experience:

2-5 years of experience and knowledge in medical services profession, payer enrollment, insurance plans, revenue cycle, or a combination of all.

Knowledge/Skills/Abilities:

Accountability - Ability to accept responsibility and account for his/her actions and work performed. Willing to accept constructive feedback.

Accuracy - Ability to perform work accurately and thoroughly with attention to all details of a project or task.

Adaptability - Ability to adapt to and facilitate change in the workplace.

Communication - Ability to communicate effectively with others using good listening skills.

Empathetic - Ability to appreciate and be sensitive to the feelings of patients and co-workers.

Initiative - Ability to make decisions and take actions to solve a problem or reach a goal. Desire to excel, attempting non-routine tasks.

Judgment - Ability to make sound decisions using available information.

Reliability - Can be relied upon to demonstrate reliability in attendance and punctuality.

Team Player - The ability to work with others and independently for a common goal. Puts aside own individual needs to work toward the larger group objective and reinforces the contribution of others.

Prior healthcare experience

Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) certification (preferred)

Must be accountable, organized and work independently to self-manage assignments

Knowledge and understanding of the credentialing process; appropriately apply principles, procedures, requirements, regulations and policies

Familiarity with CAQH, Availity, PECOS, NPPES and other common credentialing and payer enrollment tools

Thrive in a fast-paced, dynamic organization with the ability to work with and prioritize multiple assignments and deadlines while adapting to change as priorities shift.

Express thoughts and information clearly, concisely, and effectively both verbally and in writing

Critical thinker, anticipating next steps

Experience with Credential Stream preferred

Computer Proficiency, Microsoft Office to include Word, Excel, Power Point

Work Environment:
An office environment with a controlled atmosphere.