Credentialing Specialist

Regional Cancer Care Associates (RCCA) is looking for an exceptional Credentialing Specialist to join the team. This position under general supervision, applies credentialing knowledge to efficiently coordinate provider credentialing licensure and hospital privileges activities. Assists in administrative activities to support state/practice managed care functions, which may include provider plan participation and credentialing, contract files, EOB analysis, and managed care reporting. This individual must also possess strong multi-tasking abilities and bring positivity and passion to their work. If you want to join a team that is on the cutting edge of cancer care, while always putting the patient first, we want to hear from you!

Employment Type: Full Time

Location: Teaneck, NJ (Hybrid)

As of the date of this posting, RCCA offers a comprehensive benefits package for this position, subject to eligibility requirements. In addition to the salary, we provide: Health, dental, and vision plans, Wellness program, Health savings account - Flexible spending accounts, 401(k) retirement plan, Life insurance, Short-term disability insurance, Long-term disability insurance, Employee Assistance Program (EAP), Paid Time Off (PTO) and holiday pay, Tuition discounts with numerous universities, Employee-paid critical illness and accident insurance.

We believe these benefits underscore our commitment to the well-being and professional growth of our employees.

• Payer portal maintenance
• CAQH maintenance
• Credentials and re-credentials providers according to quality standards and company policies and procedures. Notifies providers of licensure expirations and submits licensure applications and renewal forms with payment to State agencies and appropriate departments.
• Recommends process improvements.
• Maintains current provider licensure files and provides information to hospitals and other healthcare providers as appropriate.
• Requests and completes hospital credentialing and privileges applications for providers.
• Obtains and maintains provider participation in managed care plans in a timely manner and communicates information to practice sites and business office.
• May implement and maintain the contract management system to include terms of the contract, providers credentialed to the payer and other contracted service providers (labs, hospitals).
• Supports Network Contracting Representative/Manager in general administrative functions.
• Trains junior and practice staff with respect to credentialing contracts, policies and procedures.
• Other duties as requested or assigned.

• High School diploma or equivalent required. Technical certification or Associates Degree a plus.
• At least five (5) years of credentialing related work experience required.
• Proficiency with computer systems and MicroSoft (Office Outlook, Word, Power Point, and Excel) required.

COMPETENCIES:

• Uses Technical and Functional Experience: Possesses up to date knowledge of the profession and industry; is regarded as an expert in the technical/functional area; accesses and uses other expert resources when appropriate.
• Demonstrates Adaptability: Handles day to day work challenges confidently; is willing and able to adjust to multiple demands, shifting priorities, ambiguity and rapid change; shows resilience in the face of constraints, frustrations, or adversity; demonstrates flexibility.
• Uses Sound Judgment: Makes timely, cost effective and sound decisions; makes decisions under conditions of uncertainty.
• Shows Work Commitment: Sets high standards of performance; pursues aggressive goals and works efficiently to achieve them.
• Commits to Quality: Emphasizes the need to deliver quality products and/or services; defines standards for quality and evaluated products, processes, and service against those standards; manages quality; improves efficiencies