Medical Staff Credentialing Director jobs in Buffalo, NY

The Community Health Center of Buffalo, Inc. is seeking an experienced Credentialing Specialist to join our team. The primary function of this role is to specialize in and perform the credentialing, privileging and enrollment process for Licensed Independent Professionals (LIP's) and Other Licensed Health Care Professionals (OLCPs) for insurance billing, in accordance with Policies and Procedures.

Responsibilities:
- Verify and ensure that all LIP and OLCPs are credentialed, appointed, enrolled, approved, and maintained to be approved by all contracted insurance companies.
- Enter and maintain all Provider information into designated credentialing databases.
- Perform primary source verification of professional education, training and employment, clinical licensure, board certifications, Drug Enforcement Administration registration, infection control, and other relevant certificates.
- Verify, review, and evaluate initial and reappointment credentialing and privileging materials for all Medical, Dental, and Behavioral Health Care Practitioners.
- Communicate with all certified and licensed staff to ensure maintenance and verification of all regulatory agencies overseeing licensure.
- Present provider credentialing documentation for Board of Directors approval, proactively at least a month before any expiration.
- Work as a liaison between the Center, the providers, and credentialing vendors to avoid gaps in the credentialing and privileging process.
- Run provider queries into the National Practitioners Data Bank for adverse charges pending or filed against the provider.
- Prepare and maintain reports of credentialing activities as requested by management.
- Send regular communication to multi-disciplinary teams related to the status of Provider credentialing.
- Work with the leadership team on any credentialing concerns that arise.
- Verify potential and existing Provider's license, DEA, and other licenses, registrations, or certificates, as necessary.
- Work with the Finance Department on Providers needing enrollment and contracts with health plans as needed.
- Request documentation, follow up on receipt of required documents, review documentation, update status of application to completion.
- Update lists and systems to reflect Provider enrollment approvals, denials, and/or terminations as needed.
- Perform additional HR duties as assigned by the supervisor.

Minimum Qualifications:
- Associates Degree in Health Care or Business related field.
- Two (2) years of relevant experience in a healthcare setting.
- Proficiency in MS Office.

Preferred Qualifications:
- Certified Provider Credentialing Specialist (CPCS)
- Bachelor’s Degree in Health Administration or another related field.
- Five (5) years of relevant experience working in a healthcare setting.
- Comprehensive level of medical terminology.
- Advanced experience in MS Office.
- Experience utilizing a credentialing database.

The salary range for this position is between $52,000 and $57,000, depending on experience.