Credentialing Coordinator

CarePoint Health Management Associates; Hoboken (NJ); Hybrid; USD 65,000 - 95,000; Full time

Benefits offered by this job

Competitive compensation

Health, dental, vision insurance

401K retirement plan

Generous PTO and holidays

Tuition reimbursement

Professional growth opportunities

Wellness programs

Job summary

CarePoint Health Management Associates is seeking a credentialing professional to oversee the enrollment and credentialing of practitioners with participating client health plans.

Under supervision, you will manage applications, verify backgrounds, and ensure compliance with Joint Commission, NCQA and CMS standards while maintaining CAQH records and payer communications.

Qualifications

• Degree in business or health-related field desired.
• CPMSM and/or CPCS Certification by the National Association Medical Staff Services required or obtained within two years of employment.
• A minimum of 2 years of experience.
• Affiliation with NAHMS and State Association encouraged.
• Excellent organizational, time management and communication skills.
• Proficiency in Cactus is critical.

Responsibilities

• Leads, coordinates, and monitors review of practitioner applications and documents.
• Conducts background investigation and primary source verification.
• Identifies issues needing investigation and follow-up.
• Prepares credentials file for other healthcare organizations.
• Responds to inquiries from healthcare organizations.
• Uses Cactus database for queries, reports and document generation; submits NPDB reports.
• Monitors credentialing processes to ensure regulatory compliance.
• Performs miscellaneous job-related duties.

Skills

CPMSM Certification

CPCS Certification

2+ years experience

Data entry

Cactus proficiency

Microsoft Office

Education

Degree in business/health field

Tools

Cactus

Microsoft Word

Excel

Access

Outlook

PowerPoint

Job description

What You'll Be Doing

The successful candidate, under the supervision of the System Director of Medical Staff Credentialing and Payor Enrollment, will be 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. The candidate will also follow 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 by 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 queries, reports 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

Full Time

Hybrid Remote Schedule

• 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.
• A minimum of 2 years of experience.
• 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 communications 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, 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 and demands, and a heavy workload.

What We Offer

• Competitive compensation based on experience and qualifications. When determining the compensation, several factors may be considered including years of relevant experience, credentials, union contracts, education and internal equity.
• Comprehensive health, dental, and vision insurance.
• 401K, Retirement savings plan.
• Generous Paid Time Off (PTO) and paid holidays.
• Tuition Reimbursement.
• Opportunities for professional growth, development, and continuing education.
• Employee wellness programs and resources.

Influenza Vaccinations are a requirement for employment. If you are not currently vaccinated you will be required to receive the vaccination prior to hire date, during the influenza season, if you are offered employment, unless you request and receive an approved medical exemption.

We are 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.