Credentialing Specialist

3 weeks ago

New York, New York, United States Careers Integrated Resources Inc Full time
Credentialing Coordinator Job Description

At Careers Integrated Resources Inc, we are seeking a highly skilled Credentialing Coordinator to join our team.

Job Summary:

The Credentialing Coordinator will be responsible for maintaining communication with credentialing contacts at facilities and provider sites to coordinate receipt of information required for credentialing, re-credentialing, and update of provider credentialing information.

Key Responsibilities:

  • Review provider re-credentialing and credentialing files for completion and presentation to the Credentialing Committee.
  • Perform primary source verification on required elements and in accordance with regulatory guidelines and client policies and procedures.
  • Data entry and upkeep of provider information in the credentialing and other pertinent databases.
  • Verify New York State OProduct, Medicare/Medicaid lists, and other pertinent databases for any current sanctions, restrictions on licensure, and/or limitations on the practice of medicine on all credentialed providers in interim credentialing periods.
  • Verify New York State license registration and DEA registration status for all credentialed providers in the interim credentialing periods.
  • Generate and disseminate monthly provider credentialing updates to appropriate departments at clients and participating facilities and provider groups.
  • Review and respond to requests for credentialing information/copies of credentialing files to appropriate departments within clients.
  • Generate and disseminate provider rosters to delegated facilities, contracted group practices, etc.
  • Perform provider roster reconciliation.
  • Create, copy, file, and maintain all relevant documentation into provider credentialing folders.
  • Maintain confidentiality of provider credentials by filing the credentialing folder in respective cabinets in the file rooms.
  • Perform annual delegated file audits and participate in pre-delegation and delegation site reviews.
  • Respond to inquiries from other client departments relative to a provider's credentialing status.

Requirements:

  • Strong communication and organizational skills.
  • Ability to work in a fast-paced environment and meet deadlines.
  • Knowledge of credentialing and re-credentialing processes and regulations.
  • Ability to maintain confidentiality and handle sensitive information.

What We Offer:

Competitive salary and benefits package.

Opportunities for professional growth and development.

A dynamic and supportive work environment.

How to Apply:

Please submit your resume and cover letter to [insert contact information].

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