Credentialing and Privileging Specialist
$47,840–$62,400 year
HybridCherry Hill, New Jersey, United States
Job Summary
Lead, coordinate, and monitor the privileging, credentialing, and re-credentialing processes for medical staff, allied health professionals, and delegated providers. Independently process practitioner applications, conduct background investigations, and verify eligibility against clinical privilege policies. Establish CAQH accounts, manage managed care credentialing audits, and submit enrollment applications to Medicare, Medicaid, and insurance providers. Maintain the credentialing database, resolve provider NPI issues, and deactivate provider numbers as needed. Provide weekly status updates, verify demographic information quarterly, and educate staff on credentialing requirements. This hybrid role in Cherry Hill, NJ, requires 3 days in office and 2 days remote work.
Required Qualifications
- High school diploma
- At least 3 years' experience
- 2 years directly related to hospital, physician group, managed care, outpatient practice or human service field credentialing
- Demonstrated ability to effectively communicate both verbally and in written form
- Ability to think and work independently
- Valid driver's license in incumbent's legal name and current address with no provisional restrictions
- Minimum 18 years of age
Desired Qualifications
- National Association Medical Staff Services (NAMSS) certification as a Certified Medical Services Manager (CPMSM)
- Certified Provider Credentials Specialist (CPCS)
- Ability to be certified within one year
- Operative knowledge of MS Office Word and Excel spreadsheets
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