Director of Credentialing

Overview

Job Title: Director, Medical Staff Affairs

Location: 225 Williamson Street, Elizabeth, NJ 07202

Facility: Trinitas Regional Medical Center

Department: Credentialing

Status: Full-Time

Shift: Day

Req #:

Pay Range: $80,000.00 - $95,000.00 per year

Location: Trinitas Regional Medical Center

Pay Transparency: The above reflects the anticipated annual salary range for this position if hired to work in New Jersey.

The compensation offered to the candidate selected for the position will depend on several factors, including the candidate's educational background, skills and professional experience.

Responsibilities

• Oversee the entire process of verifying and maintaining healthcare provider credentials, ensuring compliance with state, federal, and institutional regulations by managing a team of credentialing specialists, developing policies, monitoring data accuracy, and presenting credentialing information to relevant committees, while acting as a liaison with regulatory agencies and health plans to maintain accurate provider information and proper credentialing procedures.
• Lead and manage a team of credentialing specialists, assigning tasks, reviewing work, and ensuring timely completion of credentialing processes.
• Stay updated on all relevant credentialing regulations, including CAQH standards, state licensing requirements, and payer-specific guidelines to maintain compliance.
• Oversee the credentialing lifecycle (initial credentialing, re-credentialing, and ongoing monitoring of provider information).
• Ensure accuracy and completeness of provider data within credentialing systems, including primary source verification and regular data audits.
• Coordinate with payers to facilitate provider enrollment processes and manage delegated credentialing agreements.
• Prepare comprehensive credentialing files for review by the credentialing committee, presenting findings and addressing concerns.
• Implement quality control measures to monitor credentialing processes and identify areas for improvement.
• Generate reports on credentialing metrics, including turnaround times, compliance issues, and provider status updates.
• Collaborate with medical staff leadership, legal counsel, and other departments to address credentialing related issues.
• Maintain thorough knowledge of state and federal healthcare laws, including HIPAA and credentialing standards.
• Review complex medical records and identify potential credentialing issues.
• Communicate effectively with providers, payers, internal stakeholders, and regulatory agencies.
• Manage multiple credentialing projects simultaneously with tight deadlines.
• Analyze and implement process improvements to enhance efficiency of credentialing; conduct ongoing program evaluations and audits of data integrity.
• Coordinate with practice management, licensing agencies, insurance carriers, and other organizations to complete credentialing and re-credentialing applications.
• Direct staff and ensure consistent HR policy application, coaching, training, and performance evaluations; guide staff to confident decision-making.
• Serve as primary resource to employees regarding issues, interpretation, and application of organizational policies and procedures.
• Direct the output of the credentialing team and resolve complex credentialing problems.
• Support and contribute to the development and growth of credentialing functions.
• Work with various departments to ensure a smooth transition of providers during onboarding, new contracts, and acquisitions.
• Pursue personal continuing education and development to enhance knowledge and management skills.
• Demonstrate flexibility, organization, and the ability to function under stress; foster good public relations for the company and clients.

Qualifications

Required:

• High School Diploma or GED
• 3-5 years of relevant healthcare experience
• Ability to work in person at the hospital daily
• Strong computer skills and skills in copiers, fax machines, etc.
• Ability to present a professional image to multiple groups/stakeholders
• Ability to form collaborative relationships
• Demonstrates effective and responsive interpersonal skills - capable of gaining immediate credibility with individuals through experience, presentation, and communication skills
• Demonstrates critical and analytical skills
• Experience with effective conflict resolution skills
• Demonstrates ability to work strategically in identifying the MSO's priorities
• Exceptional communication skills - verbal and written
• Experience in data base management
• Knowledgeable about the use and implementation of technology to facilitate the work of the medical staff organization

Preferred:

• Bachelor's Degree in a related field preferred
• Certified Provider Credentialing Specialist (CPCS) and/or Certified Professional in Medical Services (CPMSM); Certification to be obtained within 3 years of hire

Essential Functions

• Lead and manage a team of credentialing specialists, assigning tasks, reviewing work, and ensuring timely completion of credentialing processes.
• Stay updated on all relevant credentialing regulations, including CAQH standards, state licensing requirements, and payer-specific guidelines to maintain compliance.
• Oversee the entire credentialing lifecycle, including initial credentialing, re-credentialing, and ongoing monitoring of provider information.
• Ensure accuracy and completeness of provider data within credentialing systems, including primary source verification and regular data audits.
• Coordinate with payers to facilitate provider enrollment processes and manage delegated credentialing agreements.
• Prepare comprehensive credentialing files for review by the credentialing committee, presenting findings and addressing any concerns.
• Implement quality control measures to monitor credentialing processes and identify areas for improvement.
• Generate reports on credentialing metrics, including turnaround times, compliance issues, and provider status updates.
• Collaborate with medical staff leadership, legal counsel, and other departments to address credentialing related issues.
• Thorough knowledge of state and federal healthcare laws, including HIPAA and credentialing standards.
• Ability to review complex medical records and identify potential credentialing issues.
• Effective communication with providers, payers, internal stakeholders, and regulatory agencies.
• Ability to manage multiple credentialing projects simultaneously with tight deadlines.
• Describes competency in process improvements, program evaluations, and audits of data integrity.
• Coordinate with practice management, licensing agencies, insurance carriers, and others to complete credentialing and re-credentialing applications.
• Manage staff including interviewing and selecting qualified candidates, coaching, training, monitoring productivity and accuracy, conducting performance evaluations, and applying HR policies.
• Serve as primary resource to employees regarding issues, interpretation and application of policies and procedures.
• Direct the output of a team engaged in credentialing of providers; resolve the most complex credentialing problems.
• Support, participate and contribute to development and growth of credentialing functions.
• Work with departments to ensure smooth provider onboarding, contract transitions, and acquisitions.
• Commit to personal continuing education and professional development.
• Show flexibility, organization, and ability to function under stress; maintain good public relations for the company and clients.

Other Duties: This job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities. Duties may change at any time with or without notice.

Benefits

• Paid Time Off (PTO)
• Medical and Prescription Drug Insurance
• Dental and Vision Insurance
• Retirement Plans
• Short & Long Term Disability
• Life & Accidental Death Insurance
• Tuition Reimbursement
• Health Care/Dependent Care Flexible Spending Accounts
• Wellness Programs
• Voluntary Benefits (e.g., Pet Insurance)
• Discounts Through Partners (e.g., NJ Devils, NJPAC, Verizon, and more)

Choosing RWJBarnabas Health

RWJBarnabas Health is the premier health care destination providing patient-centered, high-quality academic medicine in a compassionate and equitable manner, while delivering a best-in-class work experience. We honor and appreciate the privilege of creating and sustaining healthier communities, one person and one community at a time. As the leading academic health system in New Jersey, we advance innovative strategies in high-quality patient care, education, and research to address both the clinical and social determinants of health.

RWJBarnabas Health aims to truly make a unique impact in local communities throughout New Jersey, including improving health outcomes and opportunities for education and career growth.

Equal Opportunity Employer

RWJBarnabas Health is an Equal Opportunity Employer