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Credentialing Specialist

2 months ago

Red Bank, New Jersey, United States The Plastic Surgery Center Full time
The Plastic Surgery Center is in search of a meticulous and organized Credentialing Specialist to join our expanding team.

Your primary role will involve the precise and timely management of care credentialing for all healthcare providers, including licensed independent practitioners and allied health professionals, in compliance with federal, state, and departmental regulations.

You will be tasked with generating accurate reports that reflect the credentialing status and productivity metrics of our clinicians. Additionally, you will maintain current data for each provider within credentialing databases and online platforms, ensuring that licenses and certifications are renewed promptly.

Key Responsibilities:
  • Process and complete provider credentialing applications efficiently.
  • Maintain accurate and up-to-date credentialing and privileging files for all licensed independent practitioners.
  • Stay informed about current health plan and agency credentialing requirements.
  • Provide credentialing and privileging verifications as necessary.
  • Notify managed care plans of any terminations and demographic changes for licensed individual practitioners.
  • Conduct monthly audits of managed care plans to ensure accurate enrollment of all licensed independent practitioners.
  • Compile and maintain accurate monthly reports and rosters of all enrolled and credentialed practitioners, confirming correct enrollment with managed care plans.
  • Respond to inquiries from other healthcare organizations and interface with internal and external stakeholders regarding credentialing and privileging matters.
  • Assist with managed care delegated credentialing audits and perform internal file audits.
  • Utilize the credentialing database to enhance efficiency and generate necessary queries, reports, and documents.
  • Support the implementation and maintenance of processes and procedures aligned with regulatory certification guidelines related to physician credentialing.

Qualifications:
  • 1-2 years of relevant credentialing experience, with a solid understanding of medical credentialing and privileging standards.
  • Ability to manage multiple tasks effectively while prioritizing needs and meeting deadlines.
  • Strong attention to detail and accuracy.
  • Excellent written and verbal communication skills.
  • Capability to maintain confidentiality and exercise sound judgment in handling sensitive information.
  • Proficient in researching and analyzing data, with the ability to work independently with minimal supervision.

Job Type: Full-time
Benefits:
  • 401(k)
  • Dental insurance
  • Health insurance
  • Health savings account
  • Life insurance
  • Paid time off
  • Vision insurance

Schedule:
  • Monday to Friday