Credentialing Specialist

1 week 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 vital role in managing the credentialing and re-credentialing processes within the organization. This position is responsible for ensuring that all healthcare providers fulfill the essential credentialing criteria for participation.

KEY RESPONSIBILITIES:

  • Facilitate the overall provider credentialing and re-credentialing workflows while adhering to established turnaround times.
  • Ensure that credentialing and re-credentialing documentation is initiated promptly and progresses in accordance with organizational standards.
  • Oversee the provider network for any credentialing or re-credentialing gaps and take appropriate actions in line with policies and procedures.
  • Discontinue providers who fail to meet credentialing requirements.
  • Draft and send communications related to credentialing matters.
  • Investigate discrepancies in provider data.
  • Assist in compiling weekly lists 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 assess and update provider information and provide updates to management.
  • Compile reports detailing the status of credentialing activities.

BASIC QUALIFICATIONS:

  • High School Diploma
  • 2-3 years of professional experience in healthcare provider credentialing
  • Proficient in Microsoft Office Suite (Word, Excel, Access)
  • Strong written and verbal communication abilities
  • Capability to work autonomously, manage pressure, and juggle multiple tasks simultaneously
  • Excellent time management skills for handling concurrent projects

PREFERRED QUALIFICATIONS:

  • Associate or Bachelor's Degree
  • Familiarity with the credentialing/provider industry
  • Proven sense of urgency
  • Experience with systems such as EDW/Business Objects

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