Senior Credentialing Specialist

Senior Credentialing Specialist

We are growing and adding another Senior Credentialing Specialist to HR Team! The specialist will be responsible for the execution of the credentialing and privileging processes for all Neighborcare Health licensed, registered, and certified staff. Additionally will ensures the credentialing software is used to its maximum potential and that development and execution of credentialing and re-credentialing functions are in accordance with applicable government regulations and meet payer requirements.

Key responsibilities:

  • Works in concert with our other Sr. Credentialing Specialist to ensure all provider credentialing processes are completed in a timely manner and in compliance with Neighborcare Health’s policies and procedures and JCAHO and NCQA standards.
  • Evaluates the work, workflow and use of the credentialing software and recommends changes in practices and procedures to increase efficiency.
  • Manages collection of data related to provider credentialing and privileging.
  • Responsible for day-to-day activities related to processing credentialing and privileging applications for providers and Neighborcare sites to ensure providers are appropriately trained and licensed, and are assigned appropriate privileges for providing care to patients.
  • Manage database application, MD-Staff (or any subsequent credentialing database), and related standard operating procedures to ensure provider’s information is complete, accurate, and up to date.
  • Evaluates and maintains positive working relationships with outside credentialing partners, including health plans, hospitals, and government agencies. Ensures that hospital privileges are successfully obtained and maintained for relevant providers.
  • Maintains provider credentialing and privileging files to ensure confidentiality, accuracy and compliance. Re-credentials providers and staff on a timely basis to avoid a lapse in participation.
  • Prepares and maintains individual provider contracts.
  • Develops and maintains positive relationships with the Provider Enrollment team.
  • Prepares and distributes reports on credentialing and privileging activities.
  • Works with the Sr. Director Human Resources and Chief Medical Officer to develop policies and procedures related to credentialing and privileging and implements approved policies and procedures to maintain compliance.
  • Stays abreast of credentialing and legal requirements to ensure Neighborcare Health is compliant with all applicable government regulations and requirements.
  • Perform audit procedures, including reviewing transactions, documents, records, reports, policies and procedures for accuracy and effectiveness.
  • Perform other duties as assigned within job qualifications.

Required for this job:

  • Strong proficiency in credentialing software applications, MD-Staff preferred;
  • Demonstrated ability to work independently;
  • Possess a positive, service-oriented attitude with strong time management and organizational skills;
  • Strong attention to detail with exceptional follow-through to maintain workload;
  • Strong communication skills both written and verbal;
  • Structured and disciplined with a drive for quality, consistent processes;
  • Possess a continuous improvement mindset;
  • Ability to work effectively with a diverse team;
  • Proficient in Microsoft Office Suite;
  • Ability to understand, maintain and modify credentialing processes to create efficiencies while conforming to JCAHO and NCQA standards;
  • Ability to meet and comply with HIPAA standards and Neighborcare Health confidentiality policies and procedures.

Minimum Requirements:

Education:

Required:  High School diploma or equivalent

Preferred:  Bachelor’s degree

Licenses/Certifications/Registrations:

Preferred:  Certified Provider Credentialing Specialist (CPCS)

Experience:

Required:  Minimum of four (4) years’ experience in Provider Credentialing

Preferred:  Experience with MD Staff

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)

To apply to this opportunity, please visit our Careers site here: https://recruiting.ultipro.com/NEI1003/JobBoard/05b8e5e2-a441-f1ac-02fd-234422e71609/OpportunityDetail?opportunityId=bbcdb6a4-4a18-4a27-81e1-f7b04d365d12