Credentialing Lead
10 days ago
New York
Job Description Benefits Pulled from the full job description • 401(k), • Health insurance, • Paid time off, • Vision insurance, • Dental insurance Full job description Overview At Essen Health Care, we care for that! As the largest privately held multispecialty medical group in the Bronx, we provide high-quality, compassionate, and accessible medical care to some of the most vulnerable and under-served residents of New York State. Guided by a Population Health model of care, Essen has five integrated clinical divisions offering urgent care, primary care, and specialty services, as well as nursing home staffing and care management. Founded in 1999, our over 20-year commitment has fueled an unwavering dedication toward innovating a better healthcare delivery system. Essen has expanded from a single primary care office to an umbrella organization offering specialties from women’s health to endocrinology, from psychiatry to a vast array of other specialties. All clinical services are offered via telehealth or in-person at over 35 medical offices and at home through the Essen House Calls program. Essen Health Care is the place Where Care Comes Together! We are looking for the most talented and effective individuals to join our rapidly growing company. With over 1,100 employees and 400+ Practitioners, we care for over 250,000 patients annually in New York City and beyond. From medical providers to administration & operational staff, there is a career here for you. Join our team today! Job Summary Position title: Credentialing Lead Job Summary: We are seeking an experienced, detail-oriented Credentialing Lead to lead an important part of our credentialing operations. This position plays a key role in ensuring the timely and accurate credentialing and recredentialing of healthcare providers and facilities in compliance with internal policies, regulatory standards, and payor requirements. The ideal candidate will have substantial experience in payor enrollment and credentialing processes, including Medicaid, Medicare, Workers’ Compensation, as well as experience managing offshore support teams. Responsibilities • Team Leadership and Supervision, • Oversee and coordinate the activities of the credentialing team, including assigning tasks, setting priorities, and ensuring timely completion of credentialing and re-credentialing applications., • Supervise and coordinate daily credentialing activities for providers and facilities across all payor types., • Supervise and coordinate workflows with offshore credentialing teams, ensuring quality control and productivity benchmarks are achieved., • Train and mentor credentialing coordinators and offshore staff, fostering a culture of accuracy, efficiency, and accountability., • Conduct training sessions, as needed, for new hires and provide ongoing education to staff to ensure adherence to credentialing standards., • Evaluate team performance, provide constructive feedback, and conduct annual performance reviews., • Credentialing Process Management, • Ensure the accurate and timely processing of initial and re-credentialing applications for healthcare providers., • Verify primary source documentation, including licenses, certifications, malpractice insurance, and board certifications., • Monitor expiration dates for licenses and certifications, initiating renewal processes as necessary to avoid gaps., • Maintain up-to-date provider profiles in credentialing databases and directories., • Oversee, monitor, and maintain end-to-end payor enrollment processes, including initial enrollment and revalidations for Medicare, Medicaid, commercial payors, and Workers' Compensation., • Manage direct credentialing activities, ensuring adherence to payor and regulatory standards., • Lead facility credentialing efforts, including hospital affiliations, CAQH maintenance, and accreditation requirements., • Monitor credentialing pipelines, track timelines, and ensure SLAs are met., • Serve as a subject matter expert and point of escalation for complex credentialing issues., • Collaborate with internal departments (e.g., contracting, revenue cycle, compliance) to resolve enrollment or credentialing-related issues., • Perform any additional duties as applicable or as assigned by leadership, • Compliance and Quality Assurance, • Ensure compliance with regulatory requirements, including those set by NCQA, • Conduct audits of credentialing files to verify accuracy and completeness., • Develop and implement policies and procedures to improve the efficiency and effectiveness of the credentialing process., • Communication and Reporting, • Serve as the primary point of contact for internal and external stakeholders regarding credentialing matters., • Prepare and present regular reports on credentialing activities, including metrics on application processing times and compliance rates., • Address and resolve any issues or discrepancies related to provider credentials. Qualifications: • 4+ years of experience in healthcare credentialing, with at least 2 years in a supervisory or lead role preferred., • Strong understanding of payor enrollment processes for Medicare, Medicaid, commercial payors, and Workers' Compensation., • Demonstrated experience with direct credentialing processes., • Experience with facility credentialing requirements and workflows., • Experience leading and managing offshore teams, including communication, training, and quality oversight., • Proficiency in credentialing software and Microsoft Office Suite., • Ability to analyze data and generate reports., • Knowledge of healthcare regulations and accreditation standards, • Working knowledge of NCQA and CMS credentialing guidelines, • Ability to analyze data and generate reports., • Strong organizational, time management, and interpersonal skills., • Excellent written and verbal communication skills., • Associate’s or Bachelor’s degree in Healthcare Administration, Business, or a related field preferred., • Full-time position with standard business hours; additional hours may be required based on operational needs. Essen Health care is proud to be an equal opportunity employer, and we seek candidates who desire to work in and serve an ethnically diverse population. Job Type: Full-time Pay: $64,000.00 - $70,000.00 per hour Benefits: • 401(k), • Dental insurance, • Health insurance, • Paid time off, • 8 hour shift As the largest privately held multispecialty medical group in the Bronx, we provide high-quality, compassionate, and accessible medical care to some of the most vulnerable and under-served residents of New York State. Guided by a Population Health model of care, Essen has five integrated clinical divisions offering urgent care, primary care, and specialty services, as well as nursing home staffing and care management. Founded in 1999, our over 20-year commitment has fueled an unwavering dedication toward innovating a better healthcare delivery system. Essen has expanded from a single primary care office to an umbrella organization offering specialties from women’s health to endocrinology, from psychiatry to a vast array of other specialties. All clinical services are offered via telehealth or in-person at over 35 medical offices and at home through the Essen House Calls program. Essen Health Care is the place Where Care Comes Together! We are looking for the most talented and effective individuals to join our rapidly growing company. With over 1,100 employees and 400+ Practitioners, we care for over 250,000 patients annually in New York City and beyond. From medical providers to administration & operational staff, there is a career here for you. Join our team today!At Essen Health Care, we care for that! \r\n\r\nAs the largest privately held multispecialty medical group in the Bronx, we provide high-quality, compassionate, and accessible medical care to some of the most vulnerable and under-served residents of New York State. Guided by a Population Health model of care, Essen has five integrated clinical divisions offering urgent care, primary care, and specialty services, as well as nursing home staffing and care management. Founded in 1999, our over 20-year commitment has fueled an unwavering dedication toward innovating a better healthcare delivery system. Essen has expanded from a single primary care office to an umbrella organization offering specialties from women’s health to endocrinology, from psychiatry to a vast array of other specialties. All clinical services are offered via telehealth or in-person at over 35 medical offices and at home through the Essen House Calls program. \r\n\r\nEssen Health Care is the place Where Care Comes Together! We are looking for the most talented and effective individuals to join our rapidly growing company. With over 1,100 employees and 400+ Practitioners, we care for over 250,000 patients annually in New York City and beyond. From medical providers to administration & operational staff, there is a career here for you. Join our team today!
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