Credentialing Specialist

Job Overview:

The Credentialing Specialist provides coordination and completion of credentialing and recredentialing activities for new and participating providers of the Rutgers New Jersey Medical School NJMS in Newark, NJ. This position is responsible for the review and processing of governmental 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
• Knowledge and understanding of credentialing processes
• Ability to organize, prioritize work and manage multiple priorities simultaneously
• Excellent verbal and written communication skills
• Excellent attention to detail
• Ability to research and analyze data
• Ability to work independently with minimal supervision
• Proficiency with Microsoft Office products

Preferred:

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

Scheduling Requirements:

• Working Shift: Monday-Friday, 8:00AM-4:30PM
• Day Shift
• Full-Time, 40 Hours Per Week

Essential Functions:

• Work closely with New Jersey Medical School Managed Care Department
• Process and maintain credentialing and re-credentialing documents for healthcare providers
• Serves as the point of contact and liaison to providers, operations regulators and leadership on credentialing-related matters regarding Medicaid and Medicare Applications
• 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 followup to obtain required documentation, resolve identified issues, ensure timely processing and communicate updates as needed
• Regularly updates and maintains credentialing database housing provider data and documentation.
• 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 Director of Revenue Cycle 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.

Benefits and Perks:

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

• 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!

Choosing RWJBarnabas 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