Credentialing Specialist

Job Summary

Responsible for all aspects of the credentialing, re-credentialing and privileging processes for all licensed clinical staff members who provide patient care. Responsible for ensuring providers are credentialed, appointed and privileged with health plans, hospitals and patient care facilities. Maintain up to date for each provider in credentialing databases and online systems ensure timely renewal of licenses and certification.  

Duties and Responsibilities

• Compiles and maintains current and accurate data for all providers.
• Completes provider credentialing and re-credentialing applications, monitors applications and follow-up as needed.
• Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
• Maintains corporate provider contract files.
• Maintains knowledge of current health plan and agency requirements for credentialing providers.
• Sets up and maintains provider information in online credentialing databases and system.
• Tracks license and certification expirations for all providers to ensure timely renewals.
• Ensures practice addresses are current with health plans, agencies and other entities.
• Audits health plan directories for current and accurate provider information.
• Completes credentialing/re-credentialing application packets for hospital, insurance carriers and government programs. Applies for NPUI numbers for new providers, provides NPI numbers to physician offices and insurance carriers as requested. Enrolls new and updates existing providers in CAQH (on-line clearing house) according to guidelines.
• Initiates malpractice coverage application process for new providers.
• Coordinates with Accounts payable to ensure fees and premium payments are submitted for licenses, DEA certificates and malpractice coverage.
• Monitors and maintains database of all Continuing Medical Education credits obtained or programs attended by clinical staff, records additional certification earned by providers.
• Maintains confidentiality of provider information.
• Provides credentialing and privileging verification.

Requirements and Qualifications

• Associates Degree and Certified Provider Credentialing Specialist (CPCS) and minimum 2-3 Years Credentialing experience.
• High School with 5 Years credentialing experience. Medent a plus.
• Excellent verbal and written communication skills, ability to relate well with people of diverse backgrounds, training and experience.
• Proficiency with medical practice software programs, Familiarity with credentialing requirements of hospitals and insurance carriers.
• Understanding of Malpractice insurance coverages and policies.  
• Knowledge and understanding of credentialing process.
• Ability to organize and prioritize work and manage multiply priorities.
• Ability to research and analyze data.
• Ability to work independently with minimal supervision.
• Ability to establish and maintain effective working relationships with providers, management, staff and external contacts.
• Proficient use of Microsoft Office, Work, Excel and Access  

Physical Demands

• Position requires manual and finger dexterity and hand-eye coordination.
• Involves standing, sitting, and walking.
• Team member will occasionally be asked to lift and carry items weighing up to 10 pounds.

Benefits

We offer a comprehensive benefits package that includes health (with employer contribution), dental, and vision insurance, employer paid base life, and other voluntary benefits*.  Time off benefits include paid combined time off (CTO) and seven paid holidays, plus a floating holiday after one year of service.  Retirement benefits include a 401(k) with company contribution and profit sharing after one year of service.  Qualified team members become eligible to participate in medical benefits on the 1st of the month following date of hire, and retirement benefits after 90 days.   

We also provide professional development opportunities, flexible work schedules, wellness incentives, healthy vending options, and relaxed dress code on Fridays. Our community-focused culture encourages participation in local events, fundraisers, and causes chosen by our team.  We are committed to providing our employees with the resources they need to thrive both personally and professionally. 

*Other voluntary benefits include Voluntary Short Term Disability, Long Term Disability, Critical Illness, Accident Insurance, Supplemental Life Insurance, and legal and identity protection and pet insurance.

Who We Are

Excelsior Orthopaedics is a multi-specialty orthopedic practice that has been providing comprehensive care since 2002.  We have multiple locations throughout the Western New York region and a free-standing ambulatory surgery center, Buffalo Surgery Center.  Excelsior Orthopaedics offers a suite of in-house services including general orthopaedic evaluation and treatment, podiatry, physical & occupational therapy, nutrition counseling, sports training, outreach athletic training, orthopaedic express care, imaging, durable medical equipment, and an outpatient total joint program.  Buffalo Surgery Center provides surgical and procedural treatments for orthopaedic, pain and spine, podiatry, total joint replacement, and gastrointestinal patients.  Our mission is to transform the lives of our patients by restoring function and enhancing quality of life.  We are committed to innovative care that is driven by patient needs and supported by the most skilled, experienced team in Western New York.

The pay range for this position is determined based on several factors, including the candidate’s years of experience, qualifications, training, licenses, designations, and the overall market conditions.

This job description does not state or imply that the duties and responsibilities listed are the only ones required of this position.  Team members in this role will be required to perform other job-related duties at the discretion of the employer and may have additional duties assigned as necessary.  

Excelsior Orthopaedics and Buffalo Surgery Center are committed to the full inclusion of all applicants.  All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity, national origin, veteran status, or genetic information.