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Pride Health · 15 hours ago

Provider Relations Specialist

Morristown, NJ

Contract

Onsite

New Grad, Entry Level

$32/hr - $35/hr

Pride Health is seeking a Credentialing Specialist responsible for the credentialing of new providers. The role involves verifying credentials, ensuring compliance with regulatory standards, managing enrollment processes, and maintaining accurate records.

Health CareHuman ResourcesInformation Technology

Growth Opportunities

Responsibilities

Verification of Credentials: Confirm that healthcare providers (e.g., physicians, nurses, therapists) have valid and current licenses, certifications, education, and training. Verify board certifications, malpractice history, and work experience

Compliance and Regulatory Oversight: Ensure all providers meet the requirements of regulatory agencies, hospitals, and insurance networks. Maintain compliance with standards from organizations such as The Joint Commission (TJC) or NCQA

Enrollment and Privileging: Manage applications for providers to be enrolled with insurance payers (so they can bill for services). Handle the hospital privileging process, which authorizes providers to perform specific procedures within a facility

Record Maintenance: Maintain accurate and up-to-date credential files for each provider. Track expiration dates for licenses, certifications, and re-credentialing timelines

Communication and Coordination: Act as a liaison between providers, HR, medical staff offices, and payers. Communicate with the state licensing