Credentialing Specialist

RWJBarnabas Health; Somerville (NJ); On-site; USD 61,000 - 77,000; Full time

Benefits offered by this job

PTO

Health insurance

Dental & Vision Insurance

Retirement plans

Disability insurance

Life insurance

Tuition reimbursement

FSA

Wellness programs

Discounts

Job summary

RWJBarnabas Health in Somerset, NJ, seeks a Credentialing Specialist to manage credentialing and privileging for licensed independent practitioners. You will support OPPE/FPPE processes, maintain credentialing files, and prepare submissions for committee review.

The role requires an associate degree or equivalent, with 2+ years in medical staff services/credentialing. Knowledge of credentialing software is preferred, CPMSM/CPCS are desirable qualifications. Competitive benefits are provided.

Qualifications

• Associates degree or combination of education and experience deemed equivalent.
• At least two years of experience in credentialing and privileging in an acute healthcare setting.
• Knowledge of credentialing software and associated applications strongly preferred.
• Certifications CPMSM or CPCS preferred.

Responsibilities

• Perform credentialing and privileging for initial and reappointment of licensed independent practitioners.
• Facilitate OPPE and FPPE processes per regulatory standards.
• Manage credentialing workflows, denial of applications, and committee presentations.
• Verify information, identify red flags, and notify MSO leadership as required.
• Maintain credentialing files and prepare files for audits.
• Ensure compliance with regulatory standards and Medical Staff Bylaws.

Skills

Interpersonal communication

Adaptability

Education

Associates degree

CPMSM

CPCS

Tools

Credentialing software

Job description

Job Title: Credentialing Specialist

Location: RWJUH Somerset

Facility: RWJ Somerset

Department: Medical Affairs

Address: 110 Rehill Ave, Somerville, NJ 08876

Req #: 0000257930

Status: Salaried

Shift: Day

Pay Range: $61,400.00 - $76,900.00 per year

Pay Transparency:

The above reflects the anticipated annual salary range for this position if hired to work in New Jersey.

The compensation offered to the candidate selected for the position will depend on several factors, including the candidate's educational background, skills and professional experience.

A Typical Day

• The Credentialing Specialist is accountable for performing duties related to credentialing and privileging licensed independent practitioners (initial and reappointment)
• Facilitates Ongoing Professional Practice Evaluation (OPPE) and Focused Professional Practice Evaluation (FPPE) processes in accordance with regulatory standards
• Handles with discretion issues that are significant complex multidisciplinary sensitive and confidential
• Possesses and develops a strong grasp of the medical staff operations and the cultures of each affiliated institution and works to collaborates with central Medical Staff Office to facilitate timely completion of credentialing processing
• Oversees and assists with application management, audit, traffic through approval queues and committee presentation,
• Analyze verification information to include identifying red flag and or adverse information and notifying MSO leadership (local/central) in accordance with policie
• Oversee the monitoring of expiring information such as but not limited to DEA license professional liability insurance and specialty board certification status maintain and update credentials files
• Management of database entries for accuracy and completeness
• Maintenance of electronic files as required
• Effective and timely communication with central medical staff office personnel
• Timely and accurately prepare credential files for audit and submission to the Chiefs, Chairs and Committees
• Maintain a working knowledge of relevant regulatory standards ie TJC DNV and NCQA state and federal requirements and applicable Medical Staff Bylaws
• Assist with the development and implementation of credentialing and recredentialing workflows to ensure efficient and effective alignment of processes
• Assist in the development or revision of credentialing related forms
• Participation in special project teams as assigned
• Training of new staff as assigned credentialing procedures software and workflows
• Enforcement of internal procedures and controls and problem resolution
• Takes a proactive role in monitoring and assisting in improving team productivity
• Exemplifies a culture of excellence effective communication and collaboration and customer service with Medical Staff Office MSO leadership and staff internal and external customers providers and clinical and administrative leaders within RWJBarnabas Health
• Continually strives to achieve individual team and departmental goals
• Oversees and assists with application management and verification activities preliminary analysis of application and verification information

This Role Might Be For You If ...

• You have excellent interpersonal and communication skills
• You demonstrate the ability to work under minimal supervision and to adapt quickly to changes within the environment

To Be Considered

Required:

• Associates degree or combination of education and experience deemed equivalent
• At least two years of experience CVO or Medical Staff Services in an acute healthcare setting, including credentialing and privileging

Preferred:

• Knowledge of credentialing software and associated applications strongly preferred

Certifications and Licenses Required:

• Certified Professional in Medical Staff Management CPMSM or Certified Provider Credentialing Specialist CPCS preferred

Other Duties: Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Benefits and Perks:

• Paid Time Off (PTO)
• Medical and Prescription Drug Insurance
• Dental and Vision Insurance
• Retirement Plans
• Short & Long Term Disability
• Life & Accidental Death Insurance
• Tuition Reimbursement
• Health Care/Dependent Care Flexible Spending Accounts
• Wellness Programs
• Voluntary Benefits (e.g., Pet Insurance)
• Discounts Through our Partners such as NJ Devils, NJ PAC, Verizon, and more!

At RWJBarnabas Health, our market-competitive Total Rewards package provides comprehensive benefits and resources to support our employees' physical, emotional, social, and financial health.

RWJBarnabas Health is the premier health care destination providing patient-centered, high-quality academic medicine in a compassionate and equitable manner, while delivering a best-in-class work experience to every member of the team. We honor and appreciate the privilege of creating and sustaining healthier communities, one person and one community at a time. As the leading academic health system in New Jersey, we advance innovative strategies in high-quality patient care, education, and research to address both the clinical and social determinants of health.

RWJBarnabas Health aims to truly make a unique impact in local communities throughout New Jersey. From vastly improving the health of local residents to creating educational and career opportunities, this combination greatly benefits the state. We understand the growing and evolving needs of residents in New Jersey-whether that be enhancing the coordination for treating complex health conditions or improving community health through local programs and education.

Equal Opportunity Employer

RWJBarnabas Health is an Equal Opportunity Employer