Medical Credentialing Specialist

Redefine Management, LLC•Matawan, NJ

2d•Onsite

About The Position

At Redefine Healthcare, we believe in providing all patients with the highest quality of care and compassion. With our dedicated team of Neurosurgeons, Interventional Pain Management Specialists, Orthopedists, Psychiatrists, Vascular Surgeons, Physical Therapists, and Chiropractors, we pride ourselves on specializing in superior continuity of care for our patients. Redefine Healthcare is looking for a full-time Credentialing Specialist to join our expanding team of professionals in our Matawan, NJ office. You will be responsible for the oversight of our credentialing software, provider documentation, and processes for our healthcare providers with both the organization and its payors. The right candidate will be thoroughly knowledgeable with all aspects of credentialing, including payor credentialing, have initiative and a great work ethic, and looking to advance their career in a community that is always growing.

Requirements

Minimum of [2-4] years of experience in credentialing or a related field, preferably within a healthcare setting.
Solid experience with credentialing software and databases.
Strong understanding of healthcare credentialing processes, standards, and regulations.
Ability to handle sensitive and confidential information with discretion.

Nice To Haves

Bachelor’s degree in healthcare administration, Business Administration, or a related field preferred.
Medallion software experience is a plus
CPCS Certified (Preferred)

Responsibilities

Oversee initial and re-credentialing applications for healthcare providers.
Verify provider credentials, including licenses, certifications, education, training, and work history.
Maintain up-to-date records and databases of provider credentials.
Ensure compliance with accreditation standards and regulatory requirements.
Collect, review, and verify all necessary documentation from providers.
Communicate with licensing boards and other entities to confirm the accuracy of credentials.
Liaise with outsourced credentialing team.
Assist in the preparation and submission of credentialing applications to insurance companies, managed care organizations, and other relevant bodies.
Act as a resource to the billing team when claim denial reasons are related to enrollment, contracting and/or credentialing.
Monitor and ensure adherence to all federal, state, and organizational credentialing requirements and standards.
Conduct routine audits of credentialing files and documentation to ensure accuracy and compliance.
Stay current with changes in credentialing regulations and policies.
Serve as a point of contact for providers regarding credentialing inquiries and issues.
Collaborate with internal departments, such as Human Resources and Medical Staff Services, to facilitate provider onboarding and credentialing processes.
Provide support and training to internal staff on credentialing procedures and requirements.
Prepare and maintain detailed reports on credentialing status, pending applications, and compliance issues.
Ensure timely completion of credentialing tasks and meet all deadlines for submissions and renewals.