Credentialing and Privileging Specialist

Bancroft; Tyndall Village (NJ); Hybrid; USD 48,000 - 62,000; Full time

Job summary

Bancroft in Cherry Hill, NJ seeks a Credentialing and Privileging Specialist to lead, coordinate, and maintain the privileging, credentialing and re-credentialing processes. Hybrid work: 3 days in office, 2 days remote.

You will ensure compliance with accrediting and regulatory agencies, manage CAQH onboarding, and prepare credentialing files for the Board while maintaining a credentialing database.

Qualifications

• High school diploma required; 3+ years' credentialing experience in hospital/managed care/health services.
• NAMSS certification preferred: CPMSM or CPCS, or ability to certify within one year.

Responsibilities

• Lead, coordinate, monitor, and maintain privileging, credentialing, and re-credentialing processes.
• Process practitioner applications, ensuring eligibility and compliance with policy descriptions.
• Conduct background investigations, primary source verification, and data validation.
• Prepare credential files for Board presentation and ensure timely completion.
• Monitor initial, reappointment, and expiration processes for medical and allied staff across regulatory bodies.

Skills

Communication skills

MS Word

MS Excel

Education

High school diploma or equivalent

NAMSS certification (CPMSM/CPCS)

Tools

MS Word

MS Excel

Job description

Credentialing and Privileging Specialist

Location: Cherry Hill, NJ
Employment Type: Hybrid
Department: Finance

Salary Range: $47,840-$62,400

Bancroft is a leading service-provider for children and adults with autism, other intellectual or developmental disabilities or those in need of neurological rehabilitation. We provide a full continuum of highly effective services - for people of all ages and every level of abilities - based on best practices and scientifically proven techniques. Our services include special education, vocational training, supported employment, structured day programs, group home and apartment programs both on-campus and in the community, short-term behavioral stabilization services for children, and in-home and outpatient rehabilitation services. As a nonprofit organization, we are solely committed to supporting people with special needs and their families, to help make it One World. For Everyone. Bancroft is currently seeking a Credentialing and Privileging Specialist to work in our corporate headquarters located in Cherry Hill, NJ. The hybrid position will be 3 days in office and 2 days work from home.

Responsibilities

Position Summary: Responsible for leading, coordinating, monitoring and maintaining the privileging, credentialing and re-credentialing processes. Facilitates all aspects of Bancroft credentialing; including initial appointment, reappointment, clinical privilege for Medical Staff, Allied Health Professionals and all other providers outlined in the Medical Staff bylaws, policies, or related contracts. Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while maintaining a working knowledge of the statues and laws relating to credentialing. Responsible for the accuracy and integrity of the credentialing database system and related applications.

• Leads, coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility.
• Independently processes requests for privileges, ensuring compliance with criteria outlined in clinical privilege policy descriptions. Based on experience in the privileging and credentialing field, the incumbent shall exercise independent review of related data to determine if the applicant may proceed in the process or if further information is needed.
• Independently conducts thorough background investigation, research and primary source verification of all components of the application file.
• Using independent judgement and discretion, actively identifies any issues that require additional investigation and evaluation, validates discrepancies and independently assures follow up with appropriate departments and staff.
• Prepares credential files for completion and presentation to Board of Directors, ensuring file completion within time periods specified.
• Monitors the initial, reappointment and expiration process for all medical staff, Allied Professional staff, Other Health Professional staff, and delegated providers, ensuring compliance with regulatory bodies (Federal, State, CMS, Joint Commission, etc.)

1. Leads organizational and individual provider credentialing to ensure participation, including but not limited to Medicare, Medicaid and managed care insurance providers.
2. Independently establishes CAQH accounts for onboarding clinical providers and complete all CAQH applications.
3. Independently leads managed care credentialing audits; conducts internal file audits.
4. Prepare and submit enrollment applications to managed care insurance providers. Respond to any questions and complete any related follow up.
5. Promptly responds to inquiries from other healthcare organizations, internal and external customers.
6. Provides education to Bancroft staff members regarding credentialing requirements.
7. Maintain a detailed log and/or database base all pending and completed work.
8. Research and resolve any issues relating to provider/clinician NPI numbers
9. Managed the deactivation of provider numbers, effective dates, and prepared notification of deactivation status.
10. Provide weekly updates regarding status of any outstanding practitioner applications. Indicate any cause of delay in process.
11. Maintain and verify provider demographic information every 90 to 120 days for active clinical staff through various means and applicable payer portals, email notifications, phone calls, and facsimiles.

Qualifications

Education & Experience: High school diploma required: at least 3 years' experience, with 2 years directly related to hospital, physician group, managed care, outpatient practice or human service field credentialing.

Preference: National Association Medical Staff Services (NAMSS) certification as a Certified Medical Services Manager (CPMSM), or Certified Provider Credentials Specialist (CPCS), or ability to be certified within one year.

Special Skills: Demonstrated ability to effectively communicate both verbally and in written form required. Ability to think and work independently. Meet deadlines and assure that assigned projects are completed in a timely and efficient manner. Effective interpersonal skills. Operative knowledge of MS Office Word and Excel spreadsheets preferred. Valid driver's license required in incumbent's legal name and current address with no provisional restrictions. Minimum 18 years of age required.

EEO Statement

Bancroft is an Equal Opportunity Employer, and supports diversity, equity and inclusion in its hiring and employment practices, so that every team member can feel a true sense of belonging, and maximize their unique potential. To this end, all applicants will receive consideration for employment without regard to age, race, color, religion, sex, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, veteran status or any other characteristic protected by law.