Credentialing Specialist

3 weeks ago

Hauppauge, New York, United States eMDs Full time
Credentialing Specialist Job Summary

As a Credentialing Specialist at eMDs, you will play a vital role in preparing provider enrollment applications, demographic updates, and tracking metrics for all eligible provider types. Your primary responsibility will be to ensure that enrollment activities meet federal, state, and department guidelines when processing application submissions. You will maintain up-to-date data for each provider in credentialing databases and online systems, ensuring timely renewal of licenses and certifications. You will report to the Director of Credentialing and CVO.

Key Responsibilities:
  • Support the Credentialing Account Manager in their duties.
  • Compile and maintain current and accurate data for all providers.
  • Complete provider enrollment credentialing and re-credentialing applications, monitor applications, and follow up as needed.
  • Build knowledge of payer requirements and forms.
  • Assist with filing, scanning, and mailing as needed.
  • Maintain copies of current state licenses, DEA certificates, malpractice coverage, and any other required credentialing documents for all providers.
  • Prepare and send provider demographic updates.
  • Track license and certification expirations for all providers to ensure timely renewals.
  • Generate and send sign pages/application to clients.
  • Additional projects as assigned.

Requirements:
  • Understanding and knowledge of the credentialing and provider enrollment process.
  • Ability to organize and prioritize work and manage multiple priorities.
  • Excellent verbal and written communication skills, including letters, memos, and emails.
  • Excellent attention to detail.
  • Ability to research and analyze data.
  • Ability to work independently with minimal supervision.
  • Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization.

Education: Bachelor's degree preferred or two years of relevant credentialing experience. Language Skills: Employees are required to speak, read, and write English. Physical Demands/Work Environment: Must be able to lift 50 lbs. and sit for extended periods of time.

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