• Credentialing Specialist

    Job Locations US-NY-Uniondale (Long Island)
  • Overview

    The Credentialing Specialist supports the Department Head in credentialing all practice locations as well as our clinicians. The Credentialing Specialist is also responsible for maintaining accurate records, up to date licensing information for physicians/sites as well as obtaining required certifications for site readiness.

    Credentialing specialists maintain regular cooperation and compliance with all regulatory, accrediting, and membership-based organizations.  Adheres to NCQA guidelines. They create and carry out various credentialing processes in relation to physicians, medical assistants, and various other healthcare professionals. They ensure that all personnel and services adhere to facility and staff policies, department guidelines, regulations, and government laws.


    Job Responsibilities

    • Perform initial credentialing, re-credentialing and/or provider demographic updates where applicable.
    • Assist Credentialing Director with management of the re-credentialing process by generating report of providers due for re-cred, disseminate the listing to the Coordinators for processing, reconcile the list of providers due for re-cred with the listing of providers processed to ensure that all candidates for re-credentialing are identified and processed prior to the end of current enrollment cycle.
    • Maintain monthly license expiration, DEA, CDS, Infection control, Board certificates, CAQH and other database and applications, HIV qualifications assessment and ongoing maintenance for annual SADC certifications take required action to ensure providers are compliant.
    • Requisition subscription services and pay invoices for primary source verifications vendors including but not limited to CAQH, Certifacts, AMA, NTIS, NYS State Education Department of Professions, National Student Clearinghouse etc.
    • Obtaining all pertinent provider/location(s) documents and data
    • Primary Source Verifications for physicians
    • Maintaining credentials for physicians, midlevels, x ray technicians, & practice locations
    • Perform audits to ensure credentials are up to date to prevent any lapses in coverage
    • Ensure and process applications/spreadsheets with payors, state licensing boards, Federal DEA, etc are submitted completely and in a timely manner.
    • Ensure and processing of Payor applications/spreadsheets for practice locations are submitted completely and in a timely manner.
    • Maintain CAQH/One Health Port database(s) for providers and groups
    • Enrolling physicians with Medicare/Medicaid program(s)
    • Providing payors with provider/practice maintenance information rosters
    • Assist with out of state license applications for CityMD expansion
    • Input providers into EMR system and creating accounts
    • Order prescription pads for practice locations
    • Any other duties as needed.


    Minimum Qualifications

    • High School required, Associates Degree, College Preferred,
    • Credentialing experience a minimum of 3 years required.
    • Comprehensive knowledge of managed care with a specific emphasis on physician credentialing.
    • Ability to meet time-sensitive deadlines and multi-task in a changing healthcare environment.
    • Excellent communication (both verbal and written) and organizational skills.
    • Understanding of credentialing activities as they relate to initial credentialing, re-credentialing and credentials modification(s).
    • Detail-oriented, strong organizational skills and a team player who takes initiative
    • Proficient in Microsoft Office (Word, Excel, Access)
    • Must exhibit passion for outstanding results and compassion for those we work with and serve
    • Certifications preferred, but not required
    • Ability to effectively interact with physicians, insurance companies and other staff members while maintaining a high level of professionalism



    Physical requirements

    • Ability to sit and stand for periods of time.


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