Credentialing Specialist
hace 2 días
Hempstead
Job Description Job Summary: This role is responsible for managing hospital and ambulatory surgery center credentialing and privileging, tracking licenses and certifications, and maintaining credentialing files in compliance with accreditation standards. The position supports approximately 25 physicians and 15 physician assistants. Overview: The Credentialing Specialist oversees the full lifecycle of provider credentialing, recredentialing, privileging, and enrollment for physicians and advanced practice providers across hospitals, ambulatory surgery centers, and insurance payors. This role ensures ongoing compliance with all licensing, certification, privileging, and accreditation requirements, while maintaining credentialing records in accordance with hospital standards and the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF). Responsibilities include, but are not limited to: • Process initial credentialing and recredentialing applications for healthcare providers, • Prepare and submit credentialing and privileging applications for hospitals, ambulatory surgery centers, and insurance payors, • Review, verify, and process applications, including online submissions, • Conduct primary source verification of licenses, education, training, board certification, and work history, • Monitor and track expiration dates for licenses and certifications to ensure timely renewals, including state licenses, DEA, CDS, board certifications, CME, BLS, ACLS, PALS, infection control, child abuse training, and health assessments, • Maintain credentialing and privileging files in compliance with AAAASF and hospital medical staff requirements, ensuring audit readiness at all times, • Update and maintain provider data within credentialing database systems, • Track and document CME credits for providers, • Assess hospital utilization prior to renewing existing privileges, • Coordinate with hospital medical staff offices and insurance payors to ensure timely application processing and renewals, • Partner with Accounts Payable to ensure all licensing fees, application fees, and dues are paid promptly, • Generate credentialing reports and status updates as needed, • Ensure compliance with all regulatory, accreditation, and organizational credentialing standards Education Requirements: • 4–5 years of credentialing experience in a hospital, ambulatory surgery center, and/or multi-site environment, • Certified Provider Credentialing Specialist (CPCS) designation strongly preferred, • Experience with ReadyDoc credentialing system preferred (required experience noted below), Nextech experience a plus, • Demonstrated experience with hospital credentialing, privileging, and recredentialing processes, • Familiarity with ambulatory surgery center credentialing and privileging requirements, including AAAASF standards, • Experience conducting primary source verification and supporting credentialing audits, • Experience tracking provider licensure, certifications, and CME, • Experience coordinating credentialing across multiple facilities and insurance payors, • Strong organizational, communication, and computer skills, • Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint), • Experience with ReadyDoc required; Nextech preferredCompany DescriptionThe Bachrach Group (TBG) is a New York-based staffing and recruiting agency founded in 1974 by Richard Bachrach. The agency specializes in facilitating placements for professionals across various industries on a nationwide scale. TBG's overarching mission is to deliver tailored staffing solutions to its client base while simultaneously providing job seekers with career prospects. The company relies on its team of recruiters, who leverage their industry knowledge and networks to connect employers with top talent. TBG provides a comprehensive range of staffing services, including direct hire, temporary staffing, Recruitment Process Outsourcing (RPO), and contract staffing. The agency has consistently achieved notable rankings in Crain's lists, ranking as the largest search firm in NYC since 2020.The Bachrach Group (TBG) is a New York-based staffing and recruiting agency founded in 1974 by Richard Bachrach. The agency specializes in facilitating placements for professionals across various industries on a nationwide scale. TBG's overarching mission is to deliver tailored staffing solutions to its client base while simultaneously providing job seekers with career prospects. The company relies on its team of recruiters, who leverage their industry knowledge and networks to connect employers with top talent. TBG provides a comprehensive range of staffing services, including direct hire, temporary staffing, Recruitment Process Outsourcing (RPO), and contract staffing. The agency has consistently achieved notable rankings in Crain's lists, ranking as the largest search firm in NYC since 2020.