- Maintaining a thorough understanding of federal and state regulations, payer policies, and requirements in order to ensure a compliant provider employment and credentialing process for Derry Medical Center
- Performing the credentialing and privileging process in accordance with all governmental and commercial payer credentialing applications
- Collaborating closely with the Director of Human Resources and Medical Staff Coordinator to assist with DMC's provider onboarding process
- Tracking and following up on physicians' initial application/onboarding process and reappointment applications by performing primary source verification, preparing agency correspondence, and tracking responses within the organization's provider database
- Maintaining individual provider files with up to date information and completes the revalidation requests issued by all governmental and commercial payers, as well any other DMC employment requirements
- Working with necessary individuals—including physicians, Human Resources, other professional staff, and their office or clerical staff—to acquire necessary materials and information for provider certification and licensure
- Assisting in filling out and reviewing credentialing applications and other employment requirements with practitioners and other applicable staff
- Notifying applicants when further information is requested regarding their background, training, demonstrated ability, previous performance, current competence, physical and mental health status, continuing education, etc.
- Maintaining accurate provider profiles on CAQH, PECOS, CMS, and other necessary databases
- Safeguarding the integrity of privileged information, credentialing and employment files in a professional and sensitive manner
- Identifying sanctioned providers on state and federal disciplinary action reports and initiates the requisite corrective processes to address cited violations
- Querying the National Practitioner Data Bank as needed, and does so in compliance with the Healthcare Quality Improvement Act (HCQIA)
- Remaining compliant with and knowledgeable of rules and regulations set forth by the Health Information Portability and Accountability Act (HIPAA), Joint Commission standards, the HCQIA, the National Committee for Quality Assurance (NCQA), the Centers for Medicare and Medicaid Services, as well as state regulations— and relays this information to the necessary parties to ensure ongoing compliance organization-wide
- Providing all office visitors, credentialing contacts, payer representatives, and agency intermediaries with excellent customer service
- Collaborating with the billing department to help resolve and denials or authorizations issues related to provider credentialing
- Assisting the department manager and related staff with additional administrative tasks as needed
- Continuously seeking out further information and education through appropriate resources and references approved by management to research accurate answers and guidance for role and responsibilities. This includes maintaining any necessary reference guides, policies, procedures, FAQs, etc as a resource and reaching out to management and or other appropriate individuals for guidance when research performed does not provide an appropriate resolution
- Possessing high-level organizational skills and the ability to multi-task and work under pressure, while presenting a calm, professional manner and positive attitude
- High school diploma or equivalent required
- At least two years of experience in healthcare provider credentialing required
- Proven experience working directly with healthcare personnel, such as physicians, in an office setting required
- Experience with Microsoft Office Suite (Word, Excel, Outlook, etc)
- Training, education, or certification in practitioner credentialing preferred
- Competitive hourly salary
- Comprehensive medical/dental benefits at 32 hours
- Paid time off
- 401K
-
Credentialing Specialist
1 day ago
Mass General Brigham Somerville, United States**Credentialing Specialist (Remote)** · As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community by leading innovation across our system. Founded by Brigham and Women's Hospital and Massachuse ...
-
Provider Credentialing Specialist
5 days ago
DMC Primary Care Windham, United StatesDMC Primary Care, a physician-owned, independent practice, with offices throughout southern New Hampshire, has been providing comprehensive care for entire families since 1964. We help each patient achieve the best possible health through every stage of life. We do this by provid ...
-
Provider Credentialing Specialist
4 days ago
DMC Primary Care Windham, United StatesJob Description · Job DescriptionDMC Primary Care, a physician-owned, independent practice, with offices throughout southern New Hampshire, has been providing comprehensive care for entire families since 1964. We help each patient achieve the best possible health through every st ...
-
Pharmacy Credentialing Regulatory Specialist
1 week ago
Greater Lawrence Family Health Center Lawrence, United StatesEstablished in 1980, the Greater Lawrence Family Health Center (GLFHC) is a multi-site mission-driven non-profit organization employing over 700 staff whose primary focus is providing the highest quality patient care to residents throughout the Merrimack Valley. Nationally recogn ...
-
Credentialing Specialist, Home Health
2 weeks ago
connectRN Waltham, United States Full time· connectRN is the leading nurse-centric platform that is reinventing the way nurses and other healthcare professionals are finding work. By leveraging technology, connectRN connects the nursing community to flexible work opportunities and each other to build a supportive and th ...
-
Teacher I-iii
1 week ago
The State of New Hampshire Concord, United StatesState of New Hampshire Job Posting · Department of Corrections · Division of Rehabilitative Services · Concord, NH · **PART TIME · TEACHER I - III SERIES · Position #TMPPT3146 · Monday - Thursday -> 8:00a - 2:30p · $ $43.52 Hourly · The above salary does not include an additional ...
-
Education Support Services Specialist
1 day ago
Summit Technologies, Inc Fort Devens, United States**Job Description: Education Support Services Specialist** · **Job Summary**: The Education Support Services Specialist is responsible for providing comprehensive education support services to military personnel and their families in accordance with Army regulations and directive ...
-
Solutionhealth - Coding Specialist - Snhh
1 week ago
SolutionHealth Manchester, United StatesCome work at the best place to give and receive care · **Who We Are**: · **About the Job**: · The Coding Specialist is responsible for Coding, auditing, and entering all surgeries and special procedures performed in the office, ambulatory surgical center, and hospital setting usi ...
-
Veterinary Technician
6 days ago
Commonwealth Veterinary Hospital Newton, United StatesOverview: · **Commonwealth Veterinary Hospital **has an opportunity for a Full Time **Experienced **Veterinary Technician** to join our team · Commonwealth Veterinary Hospital first opened its doors in 1939. Since then, it has been a staple in the community serving its surroundin ...
-
Teacher, Mathematics
1 week ago
SAU #15 Hooksett, United States**DISTRICT**: Hooksett · **POSITION**:Classroom Teacher · **SUPERVISOR**:Principal · **POSITION GOAL**:The classroom teacher is responsible for the education of each pupil in his/her charge and for working with students, parents, other educators, and staff toward achieving the go ...
-
CT Tech Allied
1 week ago
Go Healthcare Staffing Derry, United States· Our client in Derry NH has a 10HR DAY travel position for an Allied with current CT Tech experience. · The ideal candidate must have at least 2 years of experience, with active Allied license and BLS and/or ACLS (if required) certified by the American Heart Association · Wha ...
-
Physical Therapy Assistant in Massachusetts
6 days ago
AB Staffing Methuen, United States Remote jobPhysical Therapy Assistant - Methuen, MA 01844 · Are you ready to explore new places while building your resume? At AB Staffing, we specialize in placing Allied Health providers in facilities throughout the United States. Our travel assignments range from three (3) months to one ...
-
Foundation Medical Partners
13 hours ago
SOLUTIONHEALTH Nashua, NH, United StatesCome work at the best place to give and receive care · Job Description: · Essential Duties and Responsibilities: · * Perform comprehensive health assessments on patients of all ages · * Diagnose and treat a wide range of medical conditions, including chronic diseases such as diab ...
-
nurse practitioner
6 days ago
SolutionHealth Nashua, NH , USA, United StatesCome work at the best place to give and receive care · Job Description: · Elliot Health System (EHS) in New Hampshire's vibrant Queen City of Manchester, is currently seeking a Neonatal Nurse Practitioner to join our established level III Neonatal Intensive Care Unit. · Our 30-b ...
-
Client Benefit Specialist
1 week ago
Community Council of Nashua, Inc. Nashua, United StatesJob Type · Full-time · Description · Greater Nashua Mental Health is looking for a full-time Client Benefit Specialist. The Client Benefit Specialist is responsible for overall assessment and monitoring of client financial responsibility for all services received by GNMH and as ...
-
Advance Practice Provider Lead
2 weeks ago
IHC Health Services, Inc. Nashua, NH, United States Full timeAPP Lead, Tellica Imaging (Radiology) · We are seeking a skilled and dedicated Advanced Practice Provider (APP) Lead to join Tellica Imaging in our new facility in Nashua, New Hampshire. As an APP Lead at Tellica Imaging, you will work closely with radiologists and other medical ...
-
Sleep Technologist
1 day ago
Lawrence General Hospital Lawrence, MA, United StatesA sleep technologist works under the general supervision of the medical director or designee to provide comprehensive evaluation and treatment of sleep disorders including in center and out of center sleep testing, diagnostic and therapeutic interventions, comprehensive patient c ...
-
Advanced Practice Provider Team Lead
2 weeks ago
IHC Health Services, Inc. Nashua, NH, United States Full timeAPP Lead, Tellica Imaging (Radiology) · We are seeking a skilled and dedicated Advanced Practice Provider (APP) Lead to join Tellica Imaging in our new facility in Nashua, New Hampshire. We anticipate opening doors to patients in July 2024. As an APP Lead at Tellica Imaging, you ...
-
Sleep Technologist
21 hours ago
Lawrence General Hospital Lawrence, MA, United StatesA sleep technologist works under the general supervision of the medical director or designee to provide comprehensive evaluation and treatment of sleep disorders including in center and out of center sleep testing, diagnostic and therapeutic interventions, comprehensive patient c ...
-
Medical Surgical in Massachusetts
1 week ago
AB Staffing Lawrence, United StatesMedical Surgical - Lawrence, MA 01841 · Are you ready to explore new places while building your resume? At AB Staffing, we specialize in placing Travel Nurses in facilities throughout the United States. Our travel assignments range from three (3) months to one year, and can be ad ...
provider credentialing specialist - Windham, NH , USA, United States - DMC Primary Care
Description
DMC Primary Care, a physician-owned, independent practice, with offices throughout southern New Hampshire, has been providing comprehensive care for entire families since 1964. We help each patient achieve the best possible health through every stage of life. We do this by providing an accessible, innovative healthcare experience that is built around our patient's needs.We are hiring a Provider Credentialing Specialist. This is a full-time position in Windham, NH.
The Provider Credentialing Specialist is responsible for overseeing and coordinating DMC's onboarding and credentialing process for new providers and ongoing revalidation. The credentialing specialist will acquire primary source information necessary for DMC employment, as well as both initial and reappointment application or verification with all contracted health plans to ensure that all physician and non-physician provider requirements are met.
DUTIES INCLUDE:
For more information, please visit .
We are an equal opportunity employer embracing the strength that diversity brings to the workplace. We provide a welcoming and supportive environment for employees of all ethnic backgrounds, cultures, ages, lifestyles and physical abilities.
Powered by JazzHR