Type: Contract
Start Date: ASAP
Duration: Ongoing, up to 6 Months (w/ potential for future Full-Time conversion)
Location: Manhattan, NY (HYBRID; In-Office 2 days per week)
Schedule: Monday-Friday, 8am-5pm (40 work hours per week)
Pay Range: $20 to $24 per hour
Overview: The Credentialing Coordinator serves as one of the main resources to administer the credentialing and re-credentialing activities of our client's team. This position ensures all of our client's providers meet the credentialing requirements for participation.
Responsibilities:
• Assists with managing the credentialing process and partners with doctors to ensure all paperwork is complete, accurate and accounted for including insurance applications, and internal paperwork for either employed or sublease doctors.
• Sources information from various internal databases to complete as many of the business applications as possible. Identifies missing or inaccurate data and researches the best solution, confirming accuracy including updating all applicable databases with relevant information for credentialing and insurance contracting.
• Assists in uncovering and resolving doctor credentialing questions and/or issues and recommends and creates program enhancements to better the doctor’s experience.
• Supports the overall provider credentialing and re-credentialing processes while maintaining standard turn-around times.
• Responsible to ensure the credentialing files and re-credentialing files are started on time and continue in the process according to standards.
• Monitors participating provider network for credentialing/re-credentialing deficiencies and takes necessary action per the policies and procedures.
• Terminates providers who do not comply with the credentialing standards.
• Prepares and executes outbound communications related to the credentialing events.
• Researches discrepancies related to provider information.
• Supports the preparation of weekly rosters to present providers for committee approvals/denials
• Supports credentialing audits by pulling files and preparing the files for presentation to external clients.
• Obtains missing information from various sources including the provider to ensure provider maintains compliance with our client's Network.
• Executes reports to review and make necessary updates to provider information and provide status to management.
• Prepare reports of status on credentialing activities.
BASIC QUALIFICATIONS:
• High School Diploma/GED (required).
• 2+ years of business experience with credentialing operations/healthcare provider credentialing.
• Proficient in Microsoft Office Products (Word, Excel, Access).
• Excellent communication skills (written/verbal).
• Ability to work well independently, under pressure and multi-tasking.
• Ability to successfully work on multiple projects simultaneously while managing time effectively.
PREFERRED QUALIFICATIONS:
• Associate or Bachelor’s Degree.
• Knowledge of credentialing/provider industry.
• Demonstrates sense of urgency.
• Experience with operating systems such as EDW/Business Objects.
