Credentialing Specialist

To ensure that clinical staff and health care facilities meet compliance requirements with relevant regulations. The credentialing specialist will keep records of related insurance contracts and provider credentials to ensure all necessary documents are provided to insurance companies as it pertains to their network status.

Who We Are:

JAG Physical Therapy’s care-first model of rehabilitation may be the change you are looking for! JAG Physical Therapy, a comprehensive outpatient, orthopedic physical therapy company with 150 facilities throughout Pennsylvania, New Jersey, and New York, is seeking compassionate and motivated individuals to join our winning team! JAG has been honored by the area’s top publications as the best in the business based on growth and outcomes and is considered the Gold Standard for physical therapy care by the Metro area’s largest healthcare systems and insurance providers.

What You’ll Love About Us:

• Competitive pay

• Health, Dental, & Vision Benefits

• HSA Options including dependent care, medical, and commuter benefits

• $10,000.00 Term Life Insurance benefit at NO cost to employees

• up to 3 weeks PTO

• 401(k) with company match

• Yearly review for growth opportunities

• Tuition discounts for employees and their families

• TicketsAtWork and LifeMart company perks

• Our workplace fosters a close-knit and supportive environment where individuals genuinely care for and uplift one another, creating a strong sense of unity and camaraderie

What You’ll Need:

• Knowledge of Physical and Occupational Therapy /Prompt EMR

• Associate degree or equivalent training, preferred

• 1+ year experience in credentialing providers in outpatient setting

• Detail-oriented, organized decision-maker with the ability to work both independently and in teams

• Strong oral and written communication skills

What You’ll Do:

• Ensure that all necessary licenses and credentials are verified and updated for the healthcare facility in which they work.

• Conducting background checks, contacting licensing boards, reviewing license applications, obtaining education information and obtaining references

• Assist with the new-hire process to ensure that applicants meet all licensing and credential requirements for the healthcare industry and for the specific position that is being applied for

• Using strong research skills to gather pertinent information regarding healthcare facilities and staff

• Keeping updated on medical licensing and certification requirements

• Auditing paperwork such as applications and licensing documentation for accuracy

• Understanding current healthcare laws and regulations

• Other duties as assigned

• Onboarding process for providers, including working with clinical and new therapists to ensure documentation is correct and compliant.

• Completing processes such as database, documents, and necessary credentialing.

• Coordinate the initial application, re application, and expirable process for providers and locations ensuring compliance with accrediting and regulatory agencies and insurances.

• Maintain strict confidentiality of all data and information.

• Ensure compliance with regulatory bodies, Joint Commission, NCQA, URAC, CMS, Federal and State by managing the credentialing process.

• Collaborate with internal and external groups to resolve issues and ensure accurate and timely credentialing.

• Maintain weekly reports of status of licensure and liability for all providers.

• Optimize efficiency by utilizing and maintaining the credentialing database, performing queries and generating reports.

• Obtain and update Caqh database for all providers in region.

• Maintain a complete file of all providers licensure and credentialing. Monitor renewals of licensure and liability and forward copies as needed.

• Completes 100+ expirable per month, ensuring accuracy and integrity of data within credentialing database.

• Responds to inquiries from healthcare organizations, effectively addressing daily expirable issues.

• Work with patient access inquiries to come to a common solution.

• Day to day updates for clinician transfers and new location credentialing.

• Recredentialing tasks received from supervisors.

Important Disclaimer Notice:

The above statements are only intended to represent the essential job functions and general nature of the work being performed and are not exhaustive of the tasks that an Employee may be required to perform. The employer reserves the right to revise this job description at any time and to require Employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or the work environment change. This job description is not a guarantee of employment. What you’ll love about us section is based on full time employment with the company and is not guaranteed based on employment type.