Northeast Credentialing Specialist

Position Summary

The Northeast Credentialing Specialist will be responsible for supporting national payor and facility credentialing support growing Radiology Services Organization.

Note: This role will be specifically supporting New York, New Jersey, and Pennsylvania credentialing. As a member of the Payor Contracting and Credentialing team this teammate will be a key contributor to company’s objectives by improving our credentialing execution, management and other special projects.

Position Duties and Responsibilities

• Own, track, and manage Medicare, Medicaid, and other third-party public and private payor, facility and provider enrollment and credentialing.
• Primary point of contact inside and outside of the organization for related questions and requests.
• Develop and maintain relationships with new and existing third-party payors credentialing counterparts
• Knowledgeable of credentialing process and best practices as well as staying on top of new trends and respective company impacts.
• Track, organize and provide timely update for all credentialing applications.
• Problem solves, troubleshoot and research credentialing issues independently.
• Partner and support Payor Contracting and Revenue Cycle Management (RCM) departments, patients, etc. with related ad-hoc reporting and analyses as needed.
• Creation and updating of guides, Standard Operating Procedures (SOPs), announcements, and other documentation for the department and RCM customers.
• Independently run with ad-hoc projects and other duties as assigned.

Required & Desired Professional Skills and Experience

• Required: at least 2 years of experience in the field or in a related area
• Required: experience with New York Medicare & Medicaid, NYWC and other 3rd party New York payors
• Competent in Excel, Powerpoint, Smartsheet, OneNote
• Nice to have – experience with Credential Stream and Availity
• Prior Healthcare, RCM, Credentialing, or Medical Billing experience is required
• Working knowledge and understanding of Medicare physician reimbursement methodologies is required
• Work collaboratively across multiple functions (Credentialing, RCM, and Payor Contracting)
• Highly motivated self-starter who is an excellent team player
• Outstanding organizational and communication (both verbal and written) skills
• Ability to innovate in a fast-growing work environment and comfortable dealing with ambiguity
• Ability to work independently in a complex and often fast-paced environment. A self-motivated and resourceful attitude, taking intellectual ownership of work and projects. Proactively identifying issues, prepared to address concerns/questions and make recommendations.

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