Do you want to make a difference in the lives of patients with
Cancer and Blood Disorders?
New England Cancer Specialists (NECS) is currently seeking a
full-time Monday-Friday 8 hr./5-dayCredentialing Specialist to join
our in-house Credentialing Team. This position will work
primarily off site in a remote environment but must be able to
drive to our Scarborough Clinic anywhere between 1-4 times per
month to complete assigned tasks. The Credentialing
Specialist is responsible for all aspects of the credentialing,
recredentialing, and privileging process for all medical providers
who practice at NECS. They will be responsible for ensuring
providers are credentialed, appointed, and privileged with heath
plans, hospitals, and patient care facilities. They will maintain an
up-to-date database for each provider and ensure renewal of licenses
and certifications. A minimum of 2 years’ experience credentialing
in a healthcare environment is preferred.
NECS offers competitive pay, new employees are eligible to earn
up to 3.4 weeks of Paid Time Off in their first year with the
practice, as well as an additional 10 paid company holidays. We
offer medical, dental and vision insurance and eligibility starts
the 1st of the month after your hire date.
NECS is a private medical practice composed of fifteen
oncologists and hematologists serving the region from five separate
locations in Maine and New Hampshire. Our mission is to make life
better for people with cancer and blood disorders. Kindness,
compassion, and respect are part of everything that we do - from our
phone operators to our physicians, every person on our team is
important, and everyone makes a difference every day. We are proud
to be the first Dana Farber Affiliate practice in the country,
striving to provide the highest quality care and unmatched, holistic
support for every patient, every day.
Review and process providers’ initial application and
supporting documentation to identify issues. Follow up with
healthcare provider as needed to obtain missing information.
Complete and process payer enrollment application for
healthcare providers for Medicare, commercial, managed care, and
other identified plans in the market.
Complete timely follow-up on all payer enrollment applications.
Maintain accurate provider profiles on CAQH, PECOS, NPPES,
LexisNexis, health plans and in credentialing software.
Ensure that re-credentialing is completed timely to prevent
any lapse in enrollment.
Monitor and maintain current expirable documents (Licenses,
DEAs, Board Certifications, Malpractice).
Terminating enrollment with government and commercial payers
upon resignation or termination of providers.
Updates ownership disclosures as needed.
Maintains and updates Plan of Supervisions for Advanced
Maintains all hospital appointment files and information in
database (CMHC, MMC, Mercy, Mid-Coast, SMHC, PRH, and other
hospitals as needed).
Work collaboratively with affiliated hospitals to coordinate
dually credentialed staff.
Processes applications for appointment and reappointment of
Uploads and maintains provider information in credentialing
Audits health plan directories for current and accurate
provider information and practice information and verifies on a
quarterly basis per payer’s guidelines.
Keep current with all credentialing updates or new
requirements with all payers.
Educate and/or assist healthcare providers with set up and
maintenance of provider accounts on various platforms including
but not limited to NH CME, online licensing, Parallon.
Coordinate documentation needs and verification requirements
with Human Resources team during onboarding process.
Communicate with health care providers ensuring expectations
are clear, requirements are completed in a timely manner, and
obtaining missing, incomplete, or expiring items.
Establish and maintain long-term working relationships with
payer representatives to allow for quick response with issues or
credentialing status requests.
Validate all information and completes regular attestations on
behalf of the healthcare provider.
Updates and maintains CME log for providers.
Monday-Friday work week 8:30-5:30, no nights.
Travel: Travel onsite to our Scarborough location
multiple times per month, and for all training is required.