Title: Credentialing Coordinator
Location: New York NY - Hybrid (preferably Tuesdays & Wednesdays but negotiable at least one of those days)
Duration: 4-6 month(s) (Potential temp to hire for right candidate)GENERALFUNCTION
The Credentialing Coordinator serves as one of the main resources to administer the credentialing and re-credentialing activities with the team. Ensures all Client providers meet the credentialing requirements for participation.
MAJOR DUTIES AND RESPONSIBILITIES
• 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 Client 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
2-3 years business experience with 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
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