Credentialing Specialist

CarePoint Health Management Associates; Golden Horseshoe; On-site; CAD 50,000 - 80,000; Full time

Job summary

An established healthcare provider is seeking a dedicated Credentialing Specialist to join their team. In this role, you'll be responsible for the credentialing and recredentialing of practitioners, ensuring compliance with regulatory standards. Your attention to detail and organizational skills will be crucial as you manage applications and maintain databases. This position offers a dynamic work environment where your contributions will enhance patient care and support healthcare excellence. Join a forward-thinking organization that values professional growth and offers competitive benefits, including medical, dental, and vision insurance, along with generous paid time off.

Benefits

Medical Insurance

Dental Insurance

Vision Insurance

401k with Company Match

Generous Paid Time Off

Paid Holidays

Tuition Reimbursement

Career Development Opportunities

Qualifications

• Previous experience in a Credentialing position required.
• Excellent organizational and communication skills are essential.

Responsibilities

• Responsible for credentialing and recredentialing practitioners.
• Conducts thorough background investigations and verifies application components.

Skills

Organizational Skills

Time Management

Customer Service

Oral Communication

Verbal Communication

Attention to Detail

Interpersonal Skills

Education

Degree in Business or Health-related Field

CPMSM Certification

CPCS Certification

Tools

Cactus Credentialing Database

Microsoft Word

Microsoft Excel

Microsoft Access

Microsoft Outlook

Microsoft PowerPoint

Job description

About Us

CarePoint Health is one of New Jersey’s leading health care systems comprised of three long-standing and highly-regarded hospitals – Bayonne Medical Center, Christ Hospital, and Hoboken University Medical Center. CarePoint united these three area hospitals to provide 360-degree coordinated care by integrating the medical facilities and physician networks associated with these institutions. With over 4,500 employees, CarePoint is the largest private employer in Hudson County, New Jersey, and each year provides care to over 300,000 individuals.

CarePoint prides itself on its patient-focused approach to care delivery, with an emphasis on preventative medicine, health education, and disease management. Leveraging its vast network of physicians and healthcare experts, CarePoint is quickly becoming recognized as a leader in the broader healthcare landscape as it pioneers creative solutions to address urgent population health needs.

What You'll Be Doing

The successful candidate will be able to: Under the supervision of the MSO Manager of the area, responsible for credentialing and recredentialing practitioners as well as enrollment with participating client health plans. Credentialing functions include, but are not limited to, processing credentialing applications, following up with payers, and updating and maintaining the CAQH database, following applicable state and federal requirements for Medicare and Medicaid.

• Leads, coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility.
• Conducts thorough background investigation, research, and primary source verification of all components of the application file.
• Identifies issues that require additional investigation and evaluation, validates discrepancies, and ensures appropriate follow-up.
• Prepares credentials file for completion for other healthcare organizations, ensuring file completion within specified time periods.
• Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing issues as they arise.
• Utilizes the Cactus credentialing database, optimizing efficiency, and performs query, report, and document generation; submits and retrieves National Practitioner Database reports in accordance with the Health Care Quality Improvement Act.
• Monitors the initial, reappointment, and expirable process for all medical staff, Allied Health Professional staff, Other Health Professional staff, and delegated providers, ensuring compliance with regulatory bodies (Joint Commission, NCQA, URAC, CMS, federal and state), as well as Medical Staff Bylaws, Rules and Regulations, policies and procedures, and delegated contracts.
• Performs miscellaneous job-related duties as assigned.

What We're Looking For

• Degree in business or health-related field desired. Previous experience in a Credentialing position required.
• CPMSM and/or CPCS Certification by the National Association Medical Staff Services required or obtained within two years of employment.
• Affiliation with the National Association Medical Staff Services and the State Association Medical Staff Services strongly encouraged.

• Must have excellent organizational, time management, customer service, and oral & verbal communication skills.
• Ability to focus on detail while responding to multiple tasks simultaneously and work effectively in a goal-oriented team environment.
• Must be able to maintain confidentiality of proprietary information related to all aspects of the position, hospital, medical staff, and allied health professional staff.
• Excellent interpersonal skills, including the ability to communicate clearly and professionally, both verbally and in writing, with a broad range of professionals and people of varying education and backgrounds.
• Proficiency in Cactus is critical.
• Proficiency in data entry, typing, and computer skills using a variety of software programs including Microsoft Word, Excel, Access, Outlook, PowerPoint, and Cactus.
• Willingness to maintain a flexible work schedule as needed.
• Ability to adapt to changing schedules, deadlines, demands, and a heavy workload.

What We Offer

Competitive pay, medical, dental, and vision insurance, 401k with Company match, generous paid time off, paid holidays, tuition reimbursement, and advancement and career development opportunities.

Influenza vaccinations are a requirement for employment at CarePoint Health.

CarePoint Health is an Equal Opportunity Employer encouraging diversity in the workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, gender, age, religion, disability, sexual orientation, veteran status, marital status, or any other characteristic protected by law.