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Medical Credentialing Specialist

Job Description

J & S Stark Billing & Consulting, Inc. is a Medical Billing Company specializing in physician billing. We are looking for a full time Credentialing Specialist to add to our team! We are located in Shrewsbury (Monmouth County), N.J.
J & S Stark Billing & Consulting, Inc. was established over 25 years ago & continues to earn the respect, trust & business of over 300 medical providers.
Credentialing Specialist
Credentialing specialists maintain regular cooperation and compliance with all regulatory and accrediting organizations. They create and carry out various credentialing processes in relation to physicians and healthcare providers. The specialist ensures that all personnel and services adhere to credentialing guidelines, regulations, and government laws.
Credentialing specialists process applications and reappointment paperwork, checking for completeness and accuracy. They collect and process significant amounts of verification and accreditation information, and constantly maintain and update accurate databases for both practitioners and facilities. These databases include pertinent education, training, experience, and licensure content. Credentialing specialists maintain close communication with all appropriate practitioners to ensure that records are up-to-date and consistent.
Responsibilities:
New Physicians
o Obtain a Universal Application and all required documents
o Verify all information on file with the insurance companies: tax Id, addresses, specialty, etc
o Verify info on NPI Registry.
o Verify all products within the insurance companies
o Submit all re-credentialing applications
o Verify the most recent 5-year period available for sanctions or limitations on licensure in state where the practitioner provides care
Existing Physicians
o Submit updates & corrections to insurance companies
o If physician is not participating, verify if they want to apply. If so, submit application for physician.
o Follow up on application for the status until the application has been approved
o Verify the most recent 5-year period available for sanctions or limitations on licensure in state where the practitioner provides care
PECOS
o Maintain the physicians files for revalidation or make any changes for Medicare
Medicare
o Opt Out -Login to NGS and verify if any physicians opted out of Medicare
o Revalidation List-Login to NGS every month and verify if any of our physicians are listed
CAQH
o Create and populate their CAQH file
o Maintain and update all our Doctors files
o Re-attest their file every 90 days
Delegated
o Submit updates on a monthly basis
Qualifications:
o At least 2 years credentialing experience
o High School Diploma or equivalent
o Proficient computer skills including Microsoft Word, Excel, Outlook, ability to navigate the Internet with ease, and use telephone equipment, including headset or handset
o Must be detail oriented, with strong organizational, time-management and interpersonal skills
o Demonstrate excellent reading, verbal and written communication skills, and data entry skills
o Ability to work jointly with management, supervisors, employees, clients, etc.
o Must adhere to regular and predictable attendance
Physical Demands:
The Physical demands described are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position.
o Requires sitting for extended period of time with occasional stretching, reaching, walking and stooping, pushing and/or pulling
o Must be able to type for extended periods of time
o Requires being able to hear and speak with others both in-person and on the phone
Benefits:
o Salary commensurate with experience
o Excellent Medical and Dental Plans
o Retirement plans & Life insurance options
o Vacation, holiday and sick time
o Flex schedules
Individual must be able to adapt to an ever changing, busy environment. Candidate must be reliable and a team player with a positive attitude, having excellent computer and verbal/written communication skills for provider and staff interactions.
This is a high volume, fast paced and exciting environment. We have a strong team, supportive management & offer a casual work environment.



Company Description
J & S Stark Billing & Consulting, Inc. is a Medical Billing Company specializing in physician billing. We are looking for a Denial Management Specialist to add to our team! We are located in Shrewsbury (Monmouth County), N.J.
J & S Stark Billing & Consulting, Inc. was established over 25 years ago & continues to earn the respect, trust & business of over 300 medical providers.
We are experienced in billing multiple specialties. We specialize in private practices, as well as hospital based physician practices. The specialties include, but are not limited to, Cardiology, Chemotherapy, Family Practice, Gastroenterology, Infectious Disease, Internal Medicine, Nephrology, Neurology, OB/GYN and Podiatry.



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