Title: Credentialing Specialist
Location: DocGo HQ- 35 West 35th Street, New York, NY 10001
Employment Type: Full-Time, On-site
Pay Range: $65,000-$80,000 annually
Benefits: Medical, Dental, and Vision (with company contribution), Paid Time Off, 401k
About DocGo:
DocGo is leading the proactive healthcare revolution with an innovative care delivery platform that includes mobile health services, population health, remote patient monitoring, and ambulance services. DocGo disrupts the traditional four-wall healthcare system by providing high quality, highly affordable care to patients where and when they need it. DocGo's proprietary, AI-powered technology, logistics network, and dedicated field staff of over 5,000 certified health professionals elevate the quality of patient care and drive efficiencies for municipalities, hospital networks, and health insurance providers. With Mobile Health, DocGo empowers the full promise and potential of telehealth by facilitating healthcare treatment, in tandem with a remote physician, in the comfort of a patient's home or workplace. Together with DocGo's integrated Ambulnz medical transport services, DocGo is bridging the gap between physical and virtual care.
Responsibilities:
Responsible for all credentialing processes related to compliance, regulations, and billable services.
Provide initial and reappointment applications to providers for Medicare, Medicaid, commercial and Managed Care Plans.
Responsible for adding and removing providers to / from insurance panels.
Review application packages and work with Providers and healthcare department leadership to ensure accuracy of provider identifying information, education, training, certifications, professional affiliations, licensing, claims history and work history.
Search databases for medical malpractice claims, National Provider Information, and for Medicare/Medicaid and other sanctions.
Assemble peer review letters, proof of continuing education and health clearance.
Monitors files to ensure completeness and accuracy and reviews all file documentation for compliance with quality standards, accreditation requirements and all other relevant policies.
Maintain accurate department database for providers.
Provide updated information to managed care companies to support the organization’s delegated credentialing status.
Prepare for and handle audits by managed care companies.
Provide credentialing verification to other institutions upon request and release from current or past medical staff members.
Provides routine reports to Providers and support staff regarding the status of participation in insurance plans.
Provides updates regarding managed care plan credentialing procedure changes and other relevant information.
Produces management reports regarding operations performance and/or provider credentialing status for internal management and external providers using the organization’s verification services.
Adheres to operating policies and procedures including delivery of completed work and use of resources.
Initiates correspondence to providers, users, health plans and others as necessary to obtain requisite credentialing information.
Informs management regarding the status of departmental operations and provider credentialing issues of concern.
Communicate clearly with Providers, healthcare leadership and administrative staff as needed to provide timely responses upon request on day-to-day credentialing issues as they arise.
Help build our credentialing processes in compliance with NCQA Credentials Verification Organization (CVO)
Work with Credentialing Coordinator on provider outreach for outstanding documents and documents needed for compliance with CVO standards
Work with Practice Manager to determine credentialing needs as per business strategy.
Work with Billing manager to troubleshoot any credentialling holds.
Perform additional duties as needed.
Bachelor’s degree required.
Certified Provider Credentialing Specialist (CPCS) certification required.
Minimum of two (2) years of credentialing experience in a hospital/community health center setting.
Must be proficient with PECOS, CAQH, NPPES as well as the credentialing and re-credentialing process.
Proficiency in Microsoft Office 365 and computer databases required.
Excellent written and verbal communication skills.
Capable of building strong customer relationships and delivering customer-centric service to internal/external colleagues and candidates for appointments.
A good decision-maker, with proven success at making timely decisions that keep the organization moving forward.
Adept at planning and prioritizing work to meet deadlines in a fast-paced environment.
Consistently achieving results, even under time sensitive conditions.
An effective communicator, capable of determining how best to reach different audiences and executing communications based on that understanding.
Experience at an NCQA Credentials Verification Organization (preferred)
EEO/AAP Statement: DocGo is an equal opportunity employer. We acknowledge and honor the fundamental value and dignity of all individuals. We pledge ourselves to crafting and maintaining an environment that respects diverse traditions, heritages, and experiences. DocGo is an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.
The above-noted job description is not intended to describe, in detail, the multitude of tasks that may be assigned but rather to give the applicant a general sense of the responsibilities and expectations of this position. As the nature of business demands change so, too, may the essential functions of the position.