Job Description
Job DescriptionWe are looking for a meticulous Credentialing Specialist to join our team in White Plains, New York. In this Contract-to-permanent role, you will play a vital part in managing and maintaining provider credentials while ensuring compliance with insurance and hospital requirements. The ideal candidate will excel in organization, communication, and attention to detail to support efficient operations.
Responsibilities:
• Act as a liaison between providers, credentialing companies, and insurance entities to collect necessary documentation for credentialing processes, including licenses, certificates, and other essential information.
• Maintain up-to-date provider files, ensuring proper documentation for licensing, hospital privileges, malpractice liability certificates, and other required credentials.
• Verify hospital affiliations and ensure all requirements are met for providers’ active and current affiliations.
• Submit provider credentials to insurance payers, hospitals, and credentialing firms as required.
• Organize and manage detailed records of credentialing documents and receivables using designated systems or drives.
• Analyze operational data, including co-pays, deductibles, underpayments, and denial reasons, to identify and address discrepancies.
• Ensure all fees, permits, and renewals are processed accurately and kept current to maintain compliance.
• Obtain signatures and approvals from relevant parties to finalize credentialing and re-credentialing processes.• Proven experience in credentialing processes, including provider licensing and insurance compliance.
• Proficiency in Microsoft Excel and other record-keeping tools.
• Strong organizational skills with the ability to manage multiple priorities and deadlines.
• Excellent communication skills to liaise effectively with providers, insurance companies, and credentialing firms.
• Attention to detail and accuracy in managing sensitive documentation.
• Ability to analyze data and address discrepancies efficiently.
• Knowledge of hospital affiliation processes and credentialing requirements.
• Familiarity with insurance and payer systems is highly desirable.