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Credentialing Specialist

2 months ago

New York, New York, United States Bernard Nickels & Associates Full time

TIME COMMITMENT: Full-time

JOB TYPE: Temporary

GENERAL FUNCTION:

The Credentialing Specialist plays a crucial role in managing the credentialing and re-credentialing processes within the organization. This position is responsible for ensuring that all healthcare providers meet the essential credentialing criteria for participation.

KEY RESPONSIBILITIES:

  • Facilitate the overall processes of provider credentialing and re-credentialing while adhering to established turnaround times.
  • Ensure timely initiation of credentialing and re-credentialing files, maintaining compliance with standards.
  • Monitor the network of participating providers for any credentialing or re-credentialing deficiencies and take appropriate actions as per established policies.
  • Implement termination procedures for providers who fail to meet credentialing standards.
  • Prepare and send communications related to credentialing activities.
  • Investigate discrepancies in provider information to ensure accuracy.
  • Assist in compiling weekly rosters for committee review and decision-making.
  • Support credentialing audits by organizing files for presentation to external stakeholders.
  • Gather missing information from various sources, including providers, to ensure adherence to network standards.
  • Generate reports to review and update provider information, providing status updates to management.
  • Compile reports detailing the status of credentialing activities.

BASIC QUALIFICATIONS:

  • High School Diploma
  • 2-3 years of experience in healthcare provider credentialing
  • Proficient in Microsoft Office Suite (Word, Excel, Access)
  • Strong written and verbal communication skills
  • Ability to work independently, manage pressure, and handle multiple tasks simultaneously
  • Excellent time management skills for overseeing multiple projects concurrently

PREFERRED QUALIFICATIONS:

  • Associate or Bachelor's Degree
  • Familiarity with the credentialing and provider industry
  • Demonstrated urgency in task completion
  • Experience with systems such as EDW/Business Objects