Credentialing Specialist

CREDENTIALING SPECIALIST

Coordinate all credentialing activities to ensure provider participation. Ensure provider compliance with credentialing standards.

Location: Bronx, NY 10467

Setting: : Hybrid (Wed & Friday in Office)

Schedule: Monday – Friday 8:30 am-5:30 pm (1 hour lunch)

Temp To Perm

JOB RESPONSIBILITIES:

– Coordinate provider credentialing process to increase efficiency and ensure that credentialing deadlines are met.

– Research and solve credentialing/re-credentialing delays & issues with enrollment in a timely manner.

– Manage confidential information of internal staff (Physicians, Nurse Practitioners).

– Ensure demographic updates are reviewed and verified for processing.

– Ensure the database is kept accurate and updated.

– Maintain necessary logs, lists, records, and current documentation required for physician/provider credentialing and re-credentialing to ensure requirements are met in a timely manner.

– Prepare documents for Credentialing Committee review.

– Provide productivity and issues reports for Management.

– Remain current on policies affecting provider credentials and enrollment processes.

– Perform other responsibilities as assigned.

QUALIFICATIONS:

Education: Associates/Bachelor’s Degree, and/or equivalent work experience.

Experience:

– A minimum of three (3+) years of credentialing experience.

– Required: Provider Credentialing

– Preferred: Credentialing in a Healthplan setting.

– Microsoft Office/Suite Proficient (Excel, Outlook, Word, etc.)

– Highly Organized.

– Able to multitask efficiently and effectively.

– Solid problem solving and time management skills.

– Have the ability to review and draft correspondence in email and word processing systems.

– Professional, Friendly, and Skillful Communication Skill Set