Credentialing Specialist Job at Insight Global, Morristown, NJ

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  • Insight Global
  • Morristown, NJ

Job Description

Title: Credentialing Specialist

Location: Hybrid, Morristown NJ!

Contract: 6 months+

Pay Rate: $18-$30

Day to Day:

Our top Healthcare client in NJ is looking for a Credentialing Specialists to sit in Morristown, NJ. This person will maintain credentials for Payor/Provider enrollment. They will be responsible for submission of managed care, Medicare, Medicaid applications and monitor and track these applications through the payer credentialing process.

  • Assists with the coordination of daily activities as it relates to Delegated Credentialing requirement. Ensures that verifications are within the appropriate time frames as stated by NCQA guidelines.
  • Submits complete provider files to Credentialing Corporation of America for primary source verification.
  • Performs data quality checks on files that have gone through primary source verification.
  • Review/prepares files to present at monthly AMG Credentialing Committee meeting for approval.
  • Summarizes and documents medical malpractice and adverse action claims to present to committee.
  • Submits monthly Credentialing Committee meeting minutes to Chief Medical Officer.
  • Participates in pre-delegated carrier file audits to be eligible for delegated credentialing.
  • Participates in delegated carrier file audits to remain in compliance with NCQA standards.

Must Haves:

-2+ years’ experience in Payer/Provider credentialing

-Payor Enrollment experience

- credentialing high-volume workload

-working experience using ECHO- credentialing software

-experience with CAQH- web-based data repository for credentialing data

-showing growth in experience at one company/healthcare system

Pluses :

- NAMSS certification- provider credentialing and medical services management certification

Job Tags

Contract work, Work experience placement,

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