Credentialing Specialist (21975)

As a Credentialing Specialist, you are responsible for credentialing clinical and medical staff according to policy and regulation. You will maintain an accurate, reliable credentialing status database for internal and external billing company use. You may also perform a variety of billing, posting receipts, journal entries, and reconciliation tasks assigned by CFO, Controller, Director of Revenue Cycle Management or AR Manager based on workload. You will report to the Chief Financial Officer, until the Director of Revenue Cycle Management position is filled and trained, and will work onsite in the Albany office with the revenue cycle team. Upon successful completion of training, some remote opportunities may be offered.

Responsibilities:

• Maintain an updated, shared database and Smartsheet with reminders and notice capability of all regulatory and agency required clinical/medical positions for which provide billable services or are required to register with Medicaid/Medicare based on their credential, department and position.

• Work with organizational colleagues, contractors and insurance and entitlement program representatives, for credentialing all staff and independent contractors deemed necessary.

• Prepare appropriate credentialing packages, provide list of required documents and information required to all staff and independent contractors deemed necessary. Schedule in person meetings, or by approved online platforms if in person not possible, according to credentialing grid timelines to ensure accurate filing of credentialing documents to all commercial insurers and entitlement programs with which we are in network.

• Complete credentialing applications to add providers to commercial payors and entitlement programs.

• Complete re-credentialing applications for commercial payors.

• Ensure appropriate rosters are filed with all facility-based insurers/plans.

• Maintain accurate and complete documentation of status of all active, closed, pending credentialing statuses by person/by license for each agency and location the provider will provide services.

• Provide CFO with weekly report of status of credentialing by program/provider for review with Chiefs.

• Monitor license and credential expiration dates, provider electronic reminders of required renew by dates in advance according to applicable procedure.

• Ensure the agencies, facilities and credentialed staff and contractors are maintaining compliance with regulatory and accrediting institutions.

• Maintain accurate provider profiles on all regulatory required credentialing sites, including CAQH, PECOS, NPPES, and CMS databases. This includes monitoring for providers who are removed or disassociated with our agencies, facilities.

• Complete revalidation requests issued by government payers with appropriate program Chief, CFO, and Director of Revenue Cycle Management.

• Credentialing liaison to external billing company and company partners.

Requirements and Education:

• High School Diploma required, Bachelor's Degree preferred with minimum 3 years’ experience in credentialing recommended.

Benefits

• Health care package: medical, dental, and vision 

• Tuition reimbursement 

• Paid time off 

• Holiday Pay 

• 401 (K) plan 

• Life Insurance  

• Loan repayment assistance 

• Free training/CEU opportunities