Credentialing Specialist

CarePoint Health Management Associates • Hoboken, NJ

23h

About The Position

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.

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
• Affiliation with the National Association Medical Staff Services and the State Association Medical Staff Services strongly encouraged
• Must have excellent organizational, time management, customer service and oral & verbal communications skills
• Ability to focus on detail while responding to multiple tasks simultaneously and work effectively in a goal-oriented team environment
• Must be able to maintain confidentiality of proprietary information related to all aspects of the position, hospital, medical staff and allied health professional staff
• Excellent interpersonal skills, including the ability to communicate clearly, professionally, both verbally and in writing with a broad range of professionals and people of varying education and backgrounds
• Proficiency Cactus is critical
• Proficiency in data entry, typing and computer skills using a variety of software programs including Microsoft Word, Excel, Access, Outlook, PowerPoint and Cactus
• Willingness to maintain a flexible work schedule as needed
• Ability to adapt to changing schedules, deadlines and demands, and a heavy workload
• Influenza Vaccinations are a requirement for employment. If you are not currently vaccinated you will be required to receive the vaccination prior to hire date, during the influenza season, if you are offered employment, unless you request and receive an approved medical exemption

Nice To Haves

• Affiliation with the National Association Medical Staff Services and the State Association Medical Staff Services strongly encouraged

Responsibilities

• processing credentialing applications
• following up with payers
• updating and maintaining the CAQH data base
• 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

Benefits

• Competitive compensation based on experience and qualifications: When determining the compensation, several factors may be considered including, years of relevant experience, credentials, union contracts, education, and internal equity.
• Comprehensive health, dental, and vision insurance
• 401K, Retirement savings plan
• 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: Mid Level