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Credentialing Specialist
2 months ago
Russell Tobin's client, a prominent Italian eyewear brand, is looking for a Credentialing Coordinator.
The Credentialing Coordinator acts as a key resource 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 processes of provider credentialing and re-credentialing while adhering to established turnaround times.
- *Ensures timely initiation and progression of credentialing and re-credentialing files according to set standards.
- *Monitors the network of participating providers for any credentialing or re-credentialing issues and takes appropriate actions as per company policies.
- *Initiates termination procedures for providers who fail to meet credentialing requirements.
- *Prepares and manages outbound communications related to credentialing activities.
- *Investigates discrepancies in provider information.
- *Assists in the preparation of weekly rosters for committee review and decision-making.
- *Supports credentialing audits by compiling and organizing files for external review.
- *Collects missing information from various sources, including providers, 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 experience in business operations related to healthcare provider credentialing.
- Proficient in Microsoft Office Suite (Word, Excel, Access).
- Ability to work independently, manage pressure, and multitask effectively.
- Demonstrated capability to handle multiple projects simultaneously while managing time efficiently.
Preferred Qualifications:
- Associate or Bachelor's Degree.
- Familiarity with the credentialing and provider industry.
- Exhibits a sense of urgency in completing tasks.
- Experience with systems such as EDW/Business Objects.
- 1-3 years of experience in healthcare with a focus on credentialing operations.
- Comprehensive understanding of changes in the Managed Vision Care industry, including credentialing, eligibility verification, claims processing, and payment receipt.
- Strong organizational and time management skills.
Benefits Offered by Russell Tobin:
Russell Tobin provides eligible employees with extensive healthcare coverage (medical, dental, and vision), supplemental insurance options (accident, critical illness, and hospital indemnity), a 401(k) retirement 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.
