Job Description:

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.

Job Duties:

• 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 Practice Providers.
• 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 hospital privileges.
• Uploads and maintains provider information in credentialing software (VerityStream).
• 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.

Experience and Skills:

• High School Diploma or equivalent required. Associate degree preferred.
• Two years of relevant credentialing experience required.
• Knowledge and understanding of the credentialing process.
• Ability to organize and prioritize work and manage multiple priorities.
• Excellent verbal and written communication skills including letters, memos and emails.
• Excellent attention to detail.
• Ability to research and analyze data.
• Ability to work independently with minimal supervision.
• Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization.
• Proficient use of Microsoft Office applications (Word, Excel, Access) and internet resources.

Benefits

• New England Cancer Specialists offers competitive pay and a comprehensive benefits package to our full time-employees. Our benefits include medical, prescription, dental, and vision insurances. Company-paid Life Insurance, Short Term, and Long-Term disability insurances as well as Long Term Care insurance. Other benefits include a company-sponsored retirement program, generous Paid Time Off in addition to 10 Company-paid holidays, and other voluntary benefits
• Benefits are effective 1st of the month after hire date.