Credentialing Specialist

CarePoint Health • Hoboken, NJ

86d

About The Position

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.

Requirements

• 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.
• A minimum of 2 years of experience in credentialing.
• Affiliation with the National Association Medical Staff Services and the State Association Medical Staff Services strongly encouraged.
• Excellent organizational, time management, customer service, and communication skills.
• Ability to focus on detail while managing multiple tasks simultaneously.
• Must maintain confidentiality of proprietary information.
• Excellent interpersonal skills for clear communication with a broad range of professionals.
• Proficiency in Cactus is critical.
• Proficiency in data entry and various software programs including Microsoft Office.

Nice To Haves

• Willingness to maintain a flexible work schedule as needed.
• Ability to adapt to changing schedules, deadlines, and demands.

Responsibilities

• Responsible for credentialing and recredentialing practitioners and enrollment with participating client health plans.
• Process credentialing applications and follow up with payers.
• Update and maintain the CAQH database.
• Lead and coordinate the review and analysis of practitioner applications and documents.
• Conduct thorough background investigations and primary source verifications.
• Identify issues requiring additional investigation and validate discrepancies.
• Prepare credentials files for completion for other healthcare organizations.
• Respond to inquiries from other healthcare organizations and interface with internal and external customers.
• Utilize the Cactus credentialing database for efficiency and report generation.
• Monitor the initial, reappointment, and expirable process for all medical staff and allied health professionals.
• Ensure compliance with regulatory bodies and internal policies.

Benefits

• Competitive compensation based on experience and qualifications.
• Comprehensive health, dental, and vision insurance.
• 401K, Retirement savings plan with employer contribution.
• Generous Paid Time Off (PTO) and paid holidays.
• Tuition Reimbursement.
• Opportunities for professional growth, development, and continuing education.
• Employee wellness programs and resources.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Bachelor's degree