Credentialing Coordinator

4 weeks ago


Melville, United States Professional Physical Therapy Full time

Reporting directly to the Credentialing Manager, the Credentialing Coordinator assists in ensuring applicable providers are licensed and certified as mandated by state and federal regulations, and that notification to payers is timely and complete. Responsible for monitoring and maintaining the process for credentialing and re-credentialing providers. Works with team members in the RCO to share pertinent information regarding providers credentialing status and communicates effectively. Collaborates with team members and uses applicable RCO tools and systems to ensure credentialing statuses remain current and accurate.

Hourly Rate: $23.34 - $24.40 (pay is commensurate with level of experience)

Essential Functions:
•Works with the RCO and Credentialing team on various credentialing functions, regardless of payer. Follows determined processes to monitor and maintain systematic and timely credentialing.
•Follows departmental standards and policies and procedures to ensure the accuracy of credentialing data in Professional Physical Therapy EMR database.
•Leads, coordinates, monitors the review and analysis of practitioner applications, and accompanying documents, ensure applicant eligibility.
•Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow-up.
•Prepares credentialing files for completion.
•Processes requests for privileges, ensuring compliance with criteria outlined in clinical privilege descriptions.
•Assisting in the preparation for state and federal audits, responding to auditor's inquiries and preparing responses to auditor's findings.
•Responds to inquiries from other healthcare organizations, interfaces with internal and external customers daily regarding credentialing and privileging issues and provides resolution as needed.
•Assists with managed care delegated credentialing audits; conducts internal file audits.
•Utilizes credentialing database, optimizing efficiency, performs query, report and document generation.
•Monitors the initial, reappointment and expiring licenses for all medical staff, professional staff and delegated providers, ensuring compliance with regulatory bodies.
•Participates in RCO and Credentialing meetings and ensures Credentialing functions are adhered to.
•Behaves in a manner consistent with Professional's mission, vision and values.
•Attends training classes as directed and completes assigned training courses.
•Maintains a working knowledge of HIPAA, OSHA, Risk Management and Compliance regulations.
•Practices privacy protocols in accordance with Company policies and all applicable laws and regulations.
•Performs other duties as assigned by the Credentialing Manager or RCO Management.

Requirements
•Knowledge of/proficiency with Microsoft Office is required.
•Knowledge of credentialing requirements strongly preferred.
•Detail oriented and organized with the ability to work independently and in a group setting.
•Strong research skills to gather pertinent information.
•Ability to communicate effectively, both orally and in writing.
•Ability to establish and maintain effective and cooperative working relationships with staff and others contacted in the course of work.



  • Melville, United States Infojini Healthcare Full time

    Title: Epic Credentialed TrainerDuration: 20+ weeksLocation; Melville, NYPosition Summary:Participate in and successfully complete training to become an Epic Credentialed Trainer (ECT). Support system-wide Epic implementation by training end users. Coach, mentor, and orchestrate excellence. Teach the Epic curriculum designed by Epic Principal Trainers,...


  • melville, United States Infojini Healthcare Full time

    Title: Epic Credentialed TrainerDuration: 20+ weeksLocation; Melville, NYPosition Summary:Participate in and successfully complete training to become an Epic Credentialed Trainer (ECT). Support system-wide Epic implementation by training end users. Coach, mentor, and orchestrate excellence. Teach the Epic curriculum designed by Epic Principal Trainers,...


  • Melville, New York, United States Northwell Health Full time

    Job SummaryWe are seeking a highly skilled Senior Patient Account Representative to join our team at Northwell Health. This role will be responsible for monitoring the activities and performance of physician practices to ensure that billing related functions are performed in an efficient manner consistent with department policies and procedures.Key...

  • Nurse Practitioner

    4 weeks ago


    Melville, New York, United States RMA of New York - Long Island Full time

    Job SummaryRMA of New York - Long Island is seeking a skilled Nurse Practitioner to join our team in Melville. As a key member of our Reproductive Medicine team, you will be responsible for managing IVF and RE cycles, working closely with our REI teams to provide exceptional patient care.Key ResponsibilitiesPerform ultrasound monitoring for patients in...


  • Melville, United States Northwell Health Full time

    Monitors the activities and performance of physician practices to ensure that billing related functions are performed in an efficient manner consistent with department policies and procedures.Job Responsibility Interfaces with physicians and administrators to ensure financial growth and stability; apprises physicians of new and revised procedures. Monitors...


  • Melville, United States Northwell Health Full time

    Job Description Directs, plans, organizes, and evaluates systemic approaches that contribute to the organization's Learning and Development function. Plans and directs the efficient use of budget, materials, technology and human resources. Job Responsibility Works on complex matters where analysis of issues, data, processes and situations require advanced...


  • Melville, New York, United States UHY LLP Full time

    Job Summary:The Audit Senior Manager position at UHY LLP is a key role in guiding and overseeing our clients, as well as supporting our internal leaders and the growth of our Melville, NY office.Key Responsibilities:As an Audit Senior Manager, you will be responsible for overseeing and reviewing procedures involved in planning and executing attestation...


  • Melville, United States Northwell Health Full time

    Job DescriptionJob DescriptionPerforms an age specific plan of care for a designated group of patients using the nursing process of assessment, diagnosis, outcome identification, planning, implementation and evaluation of patient care. Collaborates with physicians and other health team members in coordinating and implementing procedures and treatments. Uses...


  • Melville, United States UHY LLP Full time

    Position Summary THE FOCUS IS YOU:  We are looking to add an Audit Staff Accountant that is eager to develop the fundamental knowledge and technical skills in accounting and Audit & Assurance, to be able to ascend into a position helping lead and guide our clients. As an Audit Staff Accountant, you will be responsible for performing the necessary...

  • HNW Tax Manager

    4 months ago


    Melville, United States UHY LLP Full time

    Position Summary THE FOCUS IS YOU:  We are looking to add a Tax Manager to help guide and oversee our clients, in addition to support our internal leaders and the on-going growth in our Melville, NY office. As a Tax Manager, you will be responsible for overseeing and reviewing financial information for clients, such as business and individual tax...

  • HNW Tax Manager

    2 weeks ago


    Melville, United States UHY Full time

    Position Summary THE FOCUS IS YOU: We are looking to add a Tax Manager to help guide and oversee our clients, in addition to supporting our internal leaders and the ongoing growth in our Melville, NY office. As a Tax Manager, you will be responsible for overseeing and reviewing financial information for clients, such as business and individual tax returns,...


  • MELVILLE, United States Citizens Full time

    DescriptionAt Citizens, our mission is to help clients, colleagues and communities reach their potential. We do this through our distinguished client centric culture, having a mindset of continuous improvement and always enhancing our excellent capabilities.  Citizens stands and grows with its clients.  Within Citizens Core Banking Division, Citizens...

  • Nurse Practitioner

    2 months ago


    Melville, United States RMA of New York - Long Island Full time

    Job DescriptionEssential Functions(In compliance with the American with Disabilities Act, ADA, this description identifies the essential components of the job required to be performed with or without reasonable accommodations. Requests for reasonable accommodations to facilitate the performance of these essential functions will be given careful...


  • Melville, NY, United States Northwell Health Full time

    Job Description Job Description Performs an age specific plan of care for a designated group of patients using the nursing process of assessment, diagnosis, outcome identification, planning, implementation and evaluation of patient care. Collaborates with physicians and other health team members in coordinating and implementing procedures and treatments....