Credentialing Specialist I

New York  ‐ Onsite
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Description

Description:

  • Performs credentialing/re-credentialing duties for all HealthNow NY Inc. providers and facilities by collecting maintaining and processing the credentialing and re-credentialing information from providers.

Primary Responsibility:

  • Verifies confidential information via subscription web sites as needed for completing the credentialing and re-credentialing process: Performs necessary queries and background checks required by regulatory agencies by accessing various agency data banks and web sites
  • Ensures information is appropriately tracked in system Reviews application and information to determine if Level I II II based on specific level criteria Performs primary source verification of provider information from reports (eg DEA quarterly report)
  • Facilitates the process for the assignment of the Council for Affordable Quality Healthcare (CAQH) number as part of the credentialing process on behalf of the provider
  • Reviews provider and facility enrollment applications and certifications to obtain missing information or verification according to regulatory requirements: Contacts providers through email phone or written correspondence utilizing template
  • Responds to identified outstanding provider and facility credentialing issues and assists in resolution: Answers internal and external inquires of application status via phone and/or written correspondence Communicates with providers regarding any step or stage of the application process
  • Prepares materials for Credentials Committee for application review: Prepares data tracking reports by entering required data Assembles materials necessary for committee meetings Ensures all applicable applications are available for review by the Medical Director Performs related clerical duties: Files faxes copies documents
  • Prepares and mails or faxes delinquent credentialing or re-credentialing letters to providers and facilities Performs all job duties efficiently accurately and at an acceptable rate of performance
  • Maintains confidentiality and adheres to HIPAA regulations Delivers customer service in a professional polite and efficient manner Performs other duties of a similar nature that are necessary and not inconsistent with this position or pay grade

Knowledge and Skills (Indicate preferred or required):

  • Must meet qualifications to perform the job including satisfactory completion of all training and testing Data Entry 9000 KPH Correspondence test CRM Navigation Ability to multitask in fast paced environment Well organized with ability to adapt to changing office environment; exhibits attention to details and time management skills
  • Proficiency in English language skills including spelling punctuation and grammar in both written and verbal communication to ensure communications are issued in a professional manner
  • Ability to effectively communicate in both written and verbal communication with internal and external contacts in a professional manner
  • Working knowledge of personal computer and application software such as Microsoft Office Ability to utilize basic office equipment including PC scanner telephone copier printer fax Computer Software typically used: Microsoft Office Facets Internet

Education:

  • Required Education:HS/GED (N/A)Preferred Education:HS/GED (N/A)

Qualifications:

  • Problem Solving Skills: Recognizes and identifies gaps in credentialing applications and follows-up with providers appropriately External Contacts: Providers regulatory agency representatives

Working Conditions/Certifications/Experience:

  • 1-2 years working experience in a healthcare administrative support position; Credentialing certification from a nationally recognized organization

EEO Statement:

  • All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.
Start date
ASAP
Duration
3 months
From
Software Specialists
Published at
13.10.2016
Project ID:
1219713
Contract type
Freelance
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