Medical Staff Credentialing Specialist, Sr. jobs in Trenton, NJ

Role and Responsibilities:

Credentialing:

• Facilitates all aspects of the peer reviewer credentialing process
• Builds, maintains and updates the peer reviewer panel
  • Continuously recruits new peer reviewers to ensure a full and well-rounded panel
    • Sends out general marketing brochures and files returned responses
    • Prepares and mails informational / credentialing packages to potential peer reviewers
  • Reviews and processes credentialing applications for new peer reviewers
  • Performs re-credentialing of existing peer reviewer panel members
  • Performs and records primary and secondary source verification of peer reviewer credentials
  • Creates and maintains peer reviewer files, ensuring that files are complete
  • Documents the findings of the Chief Medical Director regarding applicants’ / peer reviewers’ applications for credentialing and/or re-credentialing
  • Advises peer reviewers of deadlines / timeframes for re-credentialing
  • Tracks pending termination actions to be taken against a peer reviewer
• Acts as a resource to peer reviewers and staff regarding the peer reviewer credentialing process
• Ensures the thoroughness, confidentiality and secure storage of peer reviewer files within the panel database, and provides retrieval of information as requested
• Participates in various special projects, as necessary (e.g., formulating specialty coding lists, revising the panel database, etc.)
• Assists the Vice President of Compliance in the development and updating of credentialing and peer reviewer policies and procedures, as requested

Administrative:

• Greets all office visitors, delivery and service providers
  • Ensures that all visitors have signed in/out via the visitor log book
  • Escorts all visitors through the office to a secure conference room or staff member office
  • Ensures that all delivery and service providers are escorted through the office at all times during the course of their delivery or service call
• Answers and directs incoming telephone calls and faxes, as needed
• Assists accounting department with bookkeeping
• Scanning documents and records
• Processes incoming and outgoing mail and overnight deliveries
• Monitors and maintains inventory of office supplies
• Monitors and maintains postage meter levels
• Travels locally to purchase office supplies and/or for postal and banking activities, as needed
• Assists with mass mailing marketing projects, as requested
• Participates in quality improvement activities
• Performs General Office Duties
• Performs other related duties, as assigned

Education, Training and Experience:

• High school diploma or its equivalent
• Experience with the process of professional credentialing
• Experience with, and a high level of comfort in, communicating with physicians
• Excellent verbal, interpersonal, communication, organizational and customer service skills
• Above average computer skills in Microsoft Office applications
• Detail oriented

Physical Demands:

• Must be able to both speak clearly and hear, as frequent use of the telephone is required
• Must have sufficient close-vision capabilities and use of hands in order to perform computer tasks
• Must be able to sit for extended periods of time
• Must be able to work under conditions of occasional stress in order to meet deadlines