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AMG Credentialing Specialist in Woodbridge Township, NJ at Pride Health

Date Posted: 4/11/2019

Job Snapshot

Job Description

Pride Health is seeking an experienced Credentialing Specialist for a highly rated medical facility in Morristown, NJ. Candidates should be comfortable and experienced with performing ALL tasks listed below:

Job Description

  • Maintains physician credentials necessary to ensure initial and continued enrollment into participating insurance plans.
  • Follows up on credentialing applications per established follow up time frames, alerts Credentialing Coordinator of any concerns, tracks applications and correspondence with insurance plans through to final completion.
  • Provides routine reports to physicians and support staff regarding the status of participation in insurance plans.
  • Updates and maintains the ECHO and CAQH databases.
  • Provides updates to the Credentialing Manager regarding managed care plan credentialing procedure changes and other relevant information.
  • Establishes a rapport with managed care plan reps to enhance the status of the facility.
  • Intake credentialing packet, prepare document checklist and cover page, alert Credentialing Manager of any concerns (not board certified, no hospital privileges etc.), establish a rapport with the practice coordinator/manager to gather missing items in order to ensure applications are released on time.
  • Maintain Provider Database, add new providers when approved to release credentialing applications, move providers who are no longer affiliated with the facility to the second tab on spreadsheet.
  • Undertakes special projects and assignments as directed by the manager.

Qualifications/Skills

  • High School Diploma
  • At least 2 years credentialing experience in a healthcare setting
  • Experience with ECHO and CAQH databases
  • Able to reliably commute to the job's location