Credentialing Specialist

Overview

Who we are

Our award-winning Bariatric Practice is based on providing exemplary customer service, while assisting patients to achieve their weight loss goals. With the support of our employees and our team of skilled bariatric surgeons, we use innovative systems to successfully get our patients on the path to improved health. We serve patients in New York, New Jersey and Connecticut.

How you’ll serve our patients

Every day is an opportunity to grow and provide better outcomes at every level. Whether your interests lie as medical staff, administrative, facilities or marketing, every individual plays an important part in our success and the success of our patients. We are a fast-paced growing practice that is always looking for new talent and great employees to enhance our team.

What is in it for you

Medical Insurance, Dental & Vision Insurance, 401k & 4% Match, Employer Paid Life and AD&D insurance, Paid Time Off and Sick Time, 7 Holidays, Career Growth & Development. Compensation is $60,000.00 to $70,000.00, depending on experience.

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.

Essential Functions:

• 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.
• Work is performed office and home office environment.

• 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.