Credentialing Specialist, AMG, Full Time - Atlantic Health System

Responsible for collecting and maintaining provider credentials necessary to ensure initial credentialing and re-credentialing with Medicare, Medicaid, and Commercial Insurance Plans. Tracks enrollment applications from submission through participating status completion. Enters specialized applicant information into a complex database and coordinates the credentialing process with the provider applicant, human resources, hospital medical staff offices, and the clinical department.


Principal Accountabilities:

Atlantic Medical Group is seeking a Full Time Credentialing Specialist.  The Selected candidate will be responsible for review of the submitted onboarding application for completeness and performing appropriate follow up with practitioner for missing information.  

• Prepare document checklist.  Establish a rapport with the physician and practice manager to gather missing items in order to ensure applications are released in a timely manner.
• Maintains physician credentials necessary to ensure initial and continued enrollment into participating insurance plans, Medicare (PECOS) and Medicaid.
• Submit payer enrollment and follows up on credentialing applications per established follow up time frames. Tracks applications and correspondence with insurance plans through to final completion. Alerts management of any concerns.
• Provides routine reports on the status of participation in insurance plans.
• Updates and maintains the ECHO and CAQH databases.
• Process demographic updates and ensure database is kept accurate and updated. Audits health plan directories/portals for current and accurate provider information. 
• Tracks license and certification expirations for all providers to ensure timely renewals
• Undertakes special projects and assignments as directed by the manager.
• Performs other duties as assigned.  

Atlantic Medical Group is a physician-led and physician-governed organization that delivers the highest quality health care, at the right place, the right price, and the right time.  We are a multispecialty physician group with more than 1,000 doctors, nurse practitioners and physician assistants at over 300 locations throughout northern and central New Jersey and northeast Pennsylvania. Our mission is to deliver exceptional care recognizing the unique needs of all those we serve. Our vision is to achieve the best outcomes with our patients at the center of the physician-led team, driven by service, innovation and continuous learning.

Our integrated network offers seamless access to Atlantic Health System’s entire health care continuum and our nationally and regionally ranked hospitals. In collaboration with Atlantic Health System, several of our practices offer urgent care and walk-in services.

In addition to primary care physicians, the team includes specialists that care for patients in all aspects of their health from pediatrics to geriatrics and everything in between. We make health decisions easier for patients with enhanced access to referrals.

EEO STATEMENT

Atlantic Health System, Inc. is an equal employment opportunity employer and federal contractor or subcontractor and therefore abides by applicable laws to protect applicants and employees from discrimination in hiring, promotion, discharge, pay, fringe benefits, job training, classification, referral, and other aspects of employment, on the basis of race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, citizenship status, disability, age, genetics, or veteran status.