Medical Credentialing Administrative Assistant - Hybrid

Everleap Fertility; Basking Ridge (NJ); On-site; USD 48,000 - 62,000; Full time

Benefits offered by this job

Medical, Dental, Vision Insurance

Paid Time Off & 8+ Paid Holidays

Company Paid Life Insurance

Long Term Disability & AD&D

Flexible Spending Accounts

Employee Assistance Program

401K Plan

Other voluntary benefits

Job summary

Everleap Fertility is seeking an organized Credentialing Administrator to support providers’ insurance credentialing across our US clinics. You will manage CAQH profiles, identify missing information, and help maintain up-to-date provider files to ensure timely credentialing and enrollment.

The role emphasizes attention to detail, strong communication, and collaboration with billing to resolve credentialing issues while maintaining compliance with plan requirements.

Qualifications

• High school diploma, GED or equivalent.
• 1 year of credentialing experience with medical staff (preferred).
• Detail oriented with ability to prioritize tasks.
• Knowledge of medical credentialing and privileging procedures (preferred).
• Excellent verbal and written communication skills.

Responsibilities

• Create CAQH profiles for new providers in our US clinics.
• Identify discrepancies or missing information and follow ups.
• Update and re-attest each provider profile quarterly and/or as needed.
• Complete and submit initial applications to commercial insurances for participation.
• Notify health plans of provider information/demographical updates and changes as well as practitioner status changes.
• Update demographic information and provide supporting documents to outside stakeholders.
• Ensure re-credentialing is completed timely to prevent lapse in enrollment.
• Respond to health plan provider inquiries.
• Work closely with billing staff to resolve denials or authorization issues.
• Maintain individual provider files with up-to-date information for credentialing.
• Maintain knowledge of current health plan and agency requirements for credentialing providers.

Skills

Detail oriented

Communication skills

Prioritization

Credentialing knowledge

1 year credentialing experience

Education

High school diploma, GED, or suitable equivalent

Job description

Credentialing Administrator

We are looking to hire an organized credentialing administrator to assist us with administrative tasks pertaining to our practitioners' insurance credentialing. The credentialing coordinator will organize, maintain, and verify all aspects of the process, and maintain current files on practitioners

Credentialing Administrator

We are looking to hire an organized credentialing administrator to assist us with administrative tasks pertaining to our practitioners' insurance credentialing. The credentialing coordinator will organize, maintain, and verify all aspects of the process, and maintain current files on practitioners. To be successful in this role you should ensure the currency and accuracy of all information.

Credentialing Coordinator Responsibilities

• Create CAQH profiles for all new providers in our US clinics.
• Identify discrepancies or missing information and conduct follow-ups.
• Update and re-attest each provider profile quarterly and/or as needed.
• Complete and submit initial applications to commercial insurances for participation.
• Notify health plans of provider information/demographical updates and changes as well as practitioner status changes
• Update demographic information and provide supporting documents to outside stakeholders, such as commercial managed care plans.
• Ensure re-credentialing is completed timely to prevent any lapse in enrollment.
• Respond to health plan provider inquiries.
• Work closely with the billing staff to identify and resolve any denials or authorization issues related to provider credentialing.
• Maintain individual provider files to include up to date information needed to complete commercial payer credentialing and recredentialing.
• Maintain knowledge of current health plan and agency requirements for credentialing providers.

Credentialing Coordinator Requirements

• High school diploma, GED, or suitable equivalent.
• 1 year of credentialing experience with medical staff. (preferred)
• Extremely detail oriented and able to prioritize tasks accordingly.
• Knowledge of medical credentialing and privileging procedures and standards. (preferred)
• Excellent verbal and written communication skills.

Everleap Fertility offers a comprehensive full-time benefits package to all employees who work a minimum of 30 hours per week.

• Medical, Dental, Vision Insurance Options
• Paid Time Off & 8+ Paid Holidays
• Company Paid Life Insurance, Long Term Disability & AD&D
• Flexible Spending Accounts
• Employee Assistance Program
• Retirement 401K Plan
• Optional benefits including STD, Life & AD&D Buy-up plans & more.

Everleap Fertility

Built on the legacy of RMA, Boston IVF, Conceptions, and six other leading North American fertility practices, Everleap Fertility brings together more than 200 physicians and embryologists across 60+ locations in the U.S., including 25 IVF laboratories focused on the next leap forward in reproductive medicine. Together, we have helped hundreds of thousands of patients build families for more than 40 years. As part of IVI Institute, Everleap Fertility contributes to a global community working together to advance the field and bring progress in reproductive medicine into patient care.

Equal Employment Opportunity Statement

Everleap Fertility is an Equal Opportunity Employer and Prohibits Discrimination and Harassment of Any Kind: Everleap Fertility is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment. All employment decisions at Everleap Fertility are based on business needs, job requirements and individual qualifications, without regard to race, color, religion and/or belief, family or parental status, or any other status protected by the laws or regulations in the locations where we operate. Everleap will not tolerate discrimination or harassment based on any of these characteristics. Everleap encourages applicants of all ages.