Job description

As the credentialing specialist the primary function is to ensure that the facility and its staff fulfill government credentialing regulations and are properly enrolled with insurance agencies.

Duties and responsibilities

• Responsible for coordinating, monitoring, and maintaining the credentialing and recredentialing process with accuracy Perform credentialing, re-credentialing and contracting processes with insurance companies.
• Insuring interpretation and compliance with the appropriate accrediting and regulatory agencies.
• Research new target insurance based on company needs within region and state.
• Negotiate contracted rates as needed based on company needs during the contracting process or re-credentialing process.
• Track license and certification expirations for all providers to ensure timely renewals.
• Contacting the insurance agencies to follow up on several stages in credentialing.
• Perform a wide variety of administrative duties.
• Oversee the maintenance of documentation, provider files and related databases.
• Maintain all insurance files.
• Update and maintain CAQH and provider database.

Qualifications

• Experience with CAQH (Council for Affordable Quality Healthcare) and credentialing laws
• Experience with NPPES (National Plan & Provider Enumeration System)
• Required experience with Medicaid & Medicare plans
• Ability to complete thorough research
• Database management
• Understanding of laws, regulations, and procedures
• Familiarity with medical terminology
• Healthcare industry, payor side experience preferred
• Certified Provider Credentialing Specialist (CPCS) Certification, Preferred
• Associates degree
• 5+ years credentialing experience

Job Type: Full-time

Pay: $65,000.00 - $70,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday

Ability to commute/relocate:

• Garden City, NY 11530: Reliably commute or planning to relocate before starting work (Required)

Experience:

• Microsoft Office: 3 years (Preferred)
• Microsoft Word: 1 year (Preferred)

Work Location: One location

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