Job Description
We are seeking a Credentialing Specialist to join our Credentialing Department at our Central Office in New York. This role is a critical part of a special project aimed at supporting the growing demands of credentialing activities—including OPPEs and FPPEs—due to the expansion of shared services and cross credentialing initiatives.
The Credentialing Specialist will facilitate all aspects of provider credentialing and privileging, ensuring compliance with regulatory and accrediting agencies. This position requires meticulous attention to detail, strong organizational skills, and a working knowledge of credentialing laws and processes.
Key Responsibilities:
Manage initial appointment, reappointment, and clinical privileging for medical and allied health providers.
Perform credential audits and background checks using MDStaff credentialing software.
Ensure data integrity and accuracy throughout all credentialing workflows.
Interpret and apply standards from accrediting bodies and regulatory agencies.
Maintain up-to-date knowledge of laws and regulations related to credentialing.
Support OPPE/FPPE and Peer Review processes using MDStat software.
Assign performance cards and reviewers in MDStat and generate associated data reports.
Qualifications:
Bachelor’s Degree required
1–2 years of experience in credentialing, with a strong preference for direct experience with OPPE/FPPE processes
Proficiency with MDStaff and MDStat platforms preferred
Certification such as CPMSM (Certified Professional Medical Services Management) or CPCS (Certified Provider Credentialing Specialist) is a plus
Strong auditing and data analysis skills
Excellent communication, organizational, and time-management abilities
Additional Details:
This is not a remote position ; all work is performed on-site at our Central Office.
This role is part of a special project , and candidates must be prepared to work in a fast-paced, evolving environment.
Application Instructions:
To apply, please submit your resume and a brief cover letter detailing your experience with credentialing and your familiarity with OPPE/FPPE processes.
Pride Global offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance, and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance, and employee discounts.
Pride Global offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance, and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance, and employee discounts.
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