Credentialing Specialist

New You Bariatric Group•Roslyn Heights, NY

20d•$60,000 - $70,000

About The Position

Description:The Credentialing Specialist is responsible for managing all aspects of provider enrollment and credentialing with federal and state agencies, commercial health plans, and other payers. This role ensures providers are enrolled accurately, efficiently, and in compliance with regulatory and organizational requirements. The Specialist works closely with internal teams to maintain active provider participation status and support timely reimbursement. The Specialist will also assist in initial credentialing, re-credentialing, and monitor upcoming renewal and expiration dates of professional licenses. Credentialing specialists often work independently. This requires the specialist to manage their workloads effectively to meet set deadlines. Strong computer and organizational skills are necessary for the input and maintenance of data, as well as performing research regarding licensing or credentialing requirements in servicing area(s). Interaction with other medical professionals, office personnel, and Payor Representatives is standard. Confidentiality of medical staff members’ personal information is a must.Work is performed office and home office environment.

Requirements

Bachelor’s Degree from an accredited university or commensurate work experience (preferred)
4+ years related credentialing experience in a healthcare setting required.
Strong understanding of Medicare/Medicaid enrollment processes and commercial payer requirements.
Experienced with provider enrollment in the Tri-State (NY, NJ, and CT), preferred
Proficiency with QGenda or similar credentialing software
Strong attention to detail and accuracy in documentation.
Proficient with Microsoft Office Suite.
Excellent organizational skills with the ability to manage multiple applications and deadlines.
Strong problem-solving skills and ability to make timely decisions in a fast-paced environment
Demonstrated ability to work in a continuously changing environment and willingness to assist with a variety of tasks as needed.
Self-starter and takes initiative.

Nice To Haves

Bachelor’s Degree from an accredited university or commensurate work experience (preferred)
Experienced with provider enrollment in the Tri-State (NY, NJ, and CT), preferred

Responsibilities

Prepare, submit, and track provider enrollment applications for Medicare, Medicaid and Commercial Plans for New York, New Jersey and Connecticut.
Maintain up-to-date knowledge of enrollment requirements, payer guidelines, and regulatory changes.
Collaborate with providers, RCM, and leadership to collect necessary information and resolve enrollment issues.
Monitor application status and follow up with payers to ensure timely processing.
Maintain accurate enrollment records in QGenda and systems.
Respond to internal and external inquiries related to network participation and enrollment status.
Maintains CAQH (Council for Affordable Quality Healthcare) profiles for current and existing providers. All profiles must be re-attested and updated with new service locations, certifications, licensures, and liability insurance.
Creates and maintains providers in QGenda.
Assist with adding additional service locations to all payors.
Assist with initial appointments, reappointment for all medical staff, allied health professionals and all other providers.
Assist with maintaining expiring licensure, DEA’s, CDS and all documentation required for credentialing and business operations.
Participate in special projects as needed.
Ability to meet crucial deadlines
Exceptional detail orientation and time management skills
Great communication skills
Proficient in Microsoft Office
Performs other duties as assigned or apparent.