Credentialing Specialist

3 weeks ago

New York, New York, United States Russell Tobin & Associates Full time



What qualities are we seeking in our Credentialing Coordinator?

Russell Tobin's client, a prominent Italian eyewear company, is in search of a Credentialing Coordinator to join their team.

The Credentialing Coordinator plays a vital role in managing the credentialing and re-credentialing processes within the organization.

Employment Type: Contract/ Hybrid

Location: New York, NY

Compensation: $20-$24/hr, based on experience

Key Responsibilities:

  • Facilitates the overall provider credentialing and re-credentialing processes while adhering to established turnaround times.
  • Ensures that credentialing and re-credentialing files are initiated promptly and processed according to organizational standards.
  • Monitors the provider network for any credentialing or re-credentialing issues and takes appropriate actions as per established policies.
  • Handles the termination of providers who fail to meet credentialing requirements.
  • Prepares and sends communications related to credentialing activities.
  • Investigates discrepancies in provider information.
  • Assists in preparing weekly rosters for committee review and decision-making.
  • Supports credentialing audits by organizing files for presentation to external stakeholders.
  • Collects missing information from various sources to ensure compliance with the EyeMed Network.
  • Generates reports to review and update provider information, providing status updates to management.
  • Prepares status reports on credentialing activities.

Qualifications:

  • High School Diploma required.
  • 2-3 years of professional experience in healthcare provider credentialing.
  • Proficient in Microsoft Office Suite (Word, Excel, Access).
  • Ability to work independently, manage multiple tasks, and perform well under pressure.
  • Strong time management skills with the capability to handle several projects simultaneously.

Preferred Qualifications:

  • Associate or Bachelor's Degree.
  • Familiarity with the credentialing and provider industry.
  • Demonstrated urgency in completing tasks.
  • Experience with operating systems such as EDW/Business Objects.
  • 1-3 years of experience in healthcare with a focus on credentialing operations.
  • Solid understanding of changes in the Managed Vision Care industry, including credentialing, eligibility verification, claims processing, and payment receipt.
  • Excellent organizational and time management skills.

Benefits offered by Russell Tobin:

Russell Tobin provides eligible employees with comprehensive healthcare coverage, including medical, dental, and vision plans, as well as supplemental coverage options, a 401(k) retirement savings plan, life and disability insurance, an employee assistance program, identity theft protection, legal support, auto and home insurance, pet insurance, and discounts with select vendors.

#CB

Compensation: $20-$24/hr, based on experience

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