Credentialing Specialist

Job Title: Credentialing Specialist

Location: SBC Corporation

Department Name: Credentialing

Req #: 48251

Status: Hourly

Shift: Day

Pay Range: $21.69 - $30.64 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.

Job Overview

The Credentialing Specialist provides coordination and completion of credentialing and re-credentialing activities for new and participating providers of the Medical Group and RWJBH Health System. This position is responsible for the review of applications, verification of credentials, timely application processing, and maintenance of provider credentialing database and related information.

Qualifications

Required

• High School Diploma or GED equivalent required

Preferred

• Associates Degree preferred
• Certified Provider Credentialing Specialist (CPCS) certification preferred
• Two years of relevant credentialing experience preferred

Essential Job Functions

• Coordinates and facilitates the credentialing process for appointment and reappointment of provider privileges to system practices, hospitals and related facilities.
• Serves as the point of contact and liaison to providers, operations, regulators, and leadership on credentialing related matters.
• Reviews credentialing applications for accuracy and completeness to verify provider meets credentialing criteria.
• Monitors application progress and submission deadlines for credentialing or re-credentialing. Conducts follow-up to obtain required documentation, resolve identified issues, ensure timely processing, and communicate updates as needed.
• Updates and maintains credentialing database housing provider data and documentation. Regularly conducts audits of the database and other related files to ensure current and accurate data.
• Maintains copies of current state licenses, certificates, malpractice coverage and any other required credentialing documents. Tracks expirations to ensure timely renewals.
• Alerts Vice President of Support Services to any information regarding licensing or credentialing issues affecting reimbursement as it pertains to providers or third parties.
• Assists in the implementation and maintenance of processes and procedures including regulatory certification guidelines related to provider credentialing.
• Responds to external inquiries according to policy and procedure, escalating inquiries as necessary.
• Other duties or special projects as assigned.

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.