Credentialing Specialist - East Brunswick, NJ
Responsible for leading, coordinating, monitoring, and maintaining the credentialing and re-credentialing process of all University Radiology physicians and affiliated medical providers. Facilitates all aspects of University Radiology Group PC credentialing, including initial appointment, reappointment, expirable process, as well as clinical privileging for Medical physicians and all other providers affiliated with University Radiology Group PC. This candidate ensures interpretation and compliance with the appropriate accrediting and regulatory agencies while developing and maintaining a working knowledge of the statues and laws relating to credentialing. Also, maintain responsibility for the accuracy and integrity of the credentialing database system and related applications working under the supervision of the Credentialing Manager.
Duties and Responsibilities:
- Leads, coordinates, and monitors the review and analysis of provider 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 to CAQH and all governing committees, ensuring file completion within time periods specified.
- Processes requests for privileges, ensuring compliance with criteria outlined in clinical privilege descriptions.
- Submit request, W9’s and locations to provider updates. Complete PPPA assessment for each location.
- Maintain medical records of each physician (annual PPD/Flu Shot Hep B), CDS renew yearly, DEA renewal.
- Bachelors degree preferred
- Minimum three (3-5) years medical office Credentialing experience.
- Direct CAQH Experience
- Knowledge of managed care payor credentialing.
- Knowledge of related accreditation and certification requirements.
- Knowledge of medical credentialing and privileging procedures and standards.
- Ability to make administrative/procedural decisions and judgments with minimal supervision.
- Strong Medical Insurance background.
- Ability to work with internal and external clients and as a team member.
- Strong Computer skills intermediate knowledge of Microsoft Office, Word, Excel and Access.