Credentialing Specialist

Hudson Regional Health

Welcome to Hudson Regional Health

Technology Transforming Care

Hudson Regional Health is a newly unified healthcare network serving Hudson County through four hospitals. Together, these hospitals form a single, integrated system with a shared visionto deliver modern, patient-first care supported by innovation. From robotic-assisted surgery and AI-powered diagnostics to real-time monitoring and precision neurosurgery, HRH is redefining what's possible in community healthcare. Patients across the region now have access to state-of-the-art procedures and nationally recognized specialists, all within a connected, local network designed to put care first.

Our Services

We focus on the care our patients need most, delivered with precision, innovation, and a commitment to excellence.

• Advanced Emergency Services - 24/7 emergency departments across all four hospitals
• Robotic-Assisted Surgery - featuring the Da Vinci XI and ExcelsiusGPS systems
• Neurosurgery & Spine Care - including Stealth Navigation and precision-guided treatment
• Women's Health & Maternity - comprehensive services tailored for every stage
• Imaging & Diagnostics - AI-enhanced systems for faster, more accurate results
• Outpatient & Specialty Care - coordinated care across multiple disciplines

Our Hospitals

Explore our hospitals and discover care that's high-tech, high-touch, and close to home:

• Secaucus University Hospital, Flagship campus featuring the Robotic Surgery Institute and modernized emergency care.
• Bayonne University Hospital, A full-service community hospital offering personalized acute care.
• Hoboken University Hospital, A local leader in women's health, family medicine, and outpatient services.
• The Heights University Hospital (Jersey City), Expanding access to state-of-the-art care in the heart of Jersey City.

What You'll Be Doing

The successful candidate will be able to: Under the supervision of the MSO Manager of the area, responsible for credentialing and recredentialing practitioners as well as enrollment with participating client health plans. Credentialing functions include, but are not limited to, processing credentialing applications, following up with payers, and updating and maintaining the CAQH data base. As well as following applicable state and federal requirements for Medicare and Medicaid.

• Leads, coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility.
• Conducts thorough background investigation, research and primary source verification of all components of the application file.
• Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.
• Prepares credentials file for completion other healthcare organizations, ensuring file completion within time periods specified.
• Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing issues as they arise.
• Utilizes the Cactus credentialing database, optimizing efficiency, and performs query, report and document generation; submits and retrieves National Practitioner Database reports in accordance with Health Care Quality Improvement Act.
• Monitors the initial, reappointment and expirable process for all medical staff, Allied Health Professional staff, Other Health Professional staff, and delegated providers, ensuring compliance with regulatory bodies (Joint Commission, NCQA, URAC, CMS, federal and state), as well as Medical Staff Bylaws, Rules and Regulations, policies and procedures, and delegated contracts.
• Performs miscellaneous job-related duties as assigned.

What We're Looking For

• Degree in business or health related field desired. Previous experience in a Credentialing position required.
• CPMSM and/or CPCS Certification by the National Association Medical Staff Services required or obtained within two years of employment.
• Affiliation with the National Association Medical Staff Services and the State Association Medical Staff Services strongly encouraged.

• Must have excellent organizational, time management, customer service and oral & verbal communications skills
• Ability to focus on detail while responding to multiple tasks simultaneously and work effectively in a goal-oriented team environment
• Must be able to maintain confidentiality of proprietary information related to all aspects of the position, hospital, medical staff and allied health professional staff
• Excellent interpersonal skills, including the ability to communicate clearly, professionally, both verbally and in writing with a broad range of professionals and people of varying education and backgrounds.
• Proficiency Cactus is critical.
• Proficiency in data entry, typing and computer skills using a variety of software programs including Microsoft Word, Excel, Access, Outlook, PowerPoint and Cactus
• Willingness to maintain a flexible work schedule as needed.
• Ability to adapt to changing schedules, deadlines and demands, and a heavy workload

What We Offer

Competitive pay Medical, dental, and vision insurance 401k with Company match Generous paid time off Paid Holidays Tuition Reimbursement Advancement and career development opportunities

Influenza Vaccinations are a requirement for employment. If you are not currently vaccinated you will be required to receive the vaccination prior to hire date, during the influenza season, if you are offered employment, unless you request and receive an approved medical exemption.

We are an Equal Opportunity Employer encouraging diversity in the workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, gender, age, religion, disability, sexual orientation, veteran status, marital status, or any other characteristic protected by law.