What are the responsibilities and job description for the Credentialing Specialist position at Redefine Healthcare?
At Redefine Healthcare, we believe in providing all patients with the highest quality of care and compassion. With our dedicated team of Neurosurgeons, Interventional Pain Management Specialists, Orthopedists, Psychiatrists, Physical Therapists, and Chiropractors, we pride ourselves on specializing in continuity of care for our patients. We are excited to add Vascular to our growing list of specialties.
Redefine Healthcare is looking for a dedicated, full-time Credentialing Specialist to join our growing credentialing department of healthcare professionals in our Matawan, NJ Office. This position will be for managing and coordinating the credentialing and re-credentialing processes for healthcare providers within the Organization. This role ensures that all necessary credentials, licenses, and certifications are obtained, verified, and maintained in compliance with federal, state, and organizational requirements.. We are looking for candidates that are motivated, compassionate and are looking to advance their career in a community that is always growing.
Job Title Duties (not limited to):
- Process initial and re-credentialing applications for healthcare providers.
- Verify provider credentials, including licenses, certifications, education, training, and work history.
- Maintain up-to-date records and databases of provider credentials.
- Ensure compliance with accreditation standards and regulatory requirements.
- Collect, review, and verify all necessary documentation from providers.
- Liaise with educational institutions, licensing boards, and other entities to confirm the accuracy of credentials.
- Prepare and submit credentialing applications to insurance companies, managed care organizations, and other relevant bodies.
- Monitor and ensure adherence to all federal, state, and organizational credentialing requirements and standards.
- Conduct routine audits of credentialing files and documentation to ensure accuracy and compliance.
- Stay current with changes in credentialing regulations and policies.
- Act as a point of contact for providers regarding credentialing inquiries and issues.
- Collaborate with internal departments, such as Human Resources and Medical Staff Services, to facilitate provider onboarding and credentialing processes.
- Provide support and training to internal staff on credentialing procedures and requirements.
- Prepare and maintain detailed reports on credentialing status, pending applications, and compliance issues.
- Ensure timely completion of credentialing tasks and meet all deadlines for submissions and renewals.
Minimum Level of Education or Experience Required:
- Bachelor’s degree in healthcare administration, Business Administration, or a related field preferred.
- Minimum of [2-4] years of experience in credentialing or a related field, preferably within a healthcare setting.
- Experience with credentialing software and databases.
- Strong understanding of healthcare credentialing processes, standards, and regulations.
- Ability to handle sensitive and confidential information with discretion.
Job Type: Full-time
Pay: $60,000.00 - $70,000.00 per year
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
- Monday to Friday
Work Location: In person
Salary : $60,000 - $70,000
