Credentialing Coordinator

5 days ago

New York, United States PROMESA R.H.C.F. Full time
Job Summary

PROMESA R.H.C.F. is seeking a highly organized and detail-oriented Credentialing Coordinator to join our team. The successful candidate will be responsible for maintaining all aspects of the credentialing process and functions related to the Credentialing Department.

Key Responsibilities
  • Maintain communication with Human Resources (HR), practitioners, and program leaders to coordinate the receipt of information required for credentialing, recredentialing, status changes, terminations, and expiring credentials.
  • Perform thorough review and analysis of provider applications, accompanying documents, and files for new and existing providers.
  • Identify discrepancies and resolve them quickly, ensuring credentialing compliance, including but not limited to, missing, incomplete, or differing information on documents.
  • Continuously evaluate file elements to determine if additional information is needed and follow up as appropriate to resolve.
  • Perform relevant primary source verifications, including licensure, registrations, certifications, affiliations, malpractice, National Practitioner Data Bank (NPDB), Office of Inspector General (OIG), Office of Medicaid Inspector General (OMIG), and other agencies as delineated by credentialing process.
  • Perform timely data entry and upkeep of provider information in the credentialing database, related spreadsheets, and credentialing file.
  • Monitor OLCP and clinical staff training per regulatory agency (tracking, notifications, pursuit, and storage).
  • Perform internal audits of credentialing files and resolve non-compliance components by pursuing missing elements and correcting erroneous documents.
  • Assist in all external audits, including Human Resource Services Administration (HRSA), Office of Alcohol and Substance Abuse Services (OASAS), The Joint Commission (TJC), Office of Mental Hygiene (OMH), and Department of Health (DOH), and managed care companies.
Requirements
  • High School Diploma/GED required. Associates degree preferred.
  • Minimum of one (1) year of experience in a Human Resources or Credentialing Department capacity in a healthcare environment, with knowledge of onboarding functions, procedures, and processes.
  • Proficient in Microsoft Office suite (i.e., Outlook, Excel, Word, and PowerPoint).
  • Type 25wpm.
  • Must display efficiency in compliance management, document management, onboarding management, and privileging management, possessing the following knowledge, skills, and attributes to fulfill credentialing goals:

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