Credentialing Specialist

2 weeks ago

New York, New York, United States RTA US Full time
Job Overview

RTA US, a prominent player in the eyewear industry, is looking for a Credentialing Specialist.

The Credentialing Specialist will be a key contributor 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 provider credentialing and re-credentialing processes while adhering to established turnaround times.
  • Ensures that credentialing and re-credentialing files are initiated promptly and progress according to organizational standards.
  • Monitors the provider network for any credentialing or re-credentialing deficiencies and takes appropriate actions as per company policies.
  • Handles the termination of providers who fail to meet credentialing standards.
  • Prepares and manages communications related to credentialing activities.
  • Investigates discrepancies in provider information.
  • Assists in the preparation of weekly rosters for committee reviews and decisions.
  • Supports credentialing audits by organizing files for external review.
  • Collects missing information from various sources to ensure compliance with network standards.
  • 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 focusing on credentialing operations.
  • Comprehensive understanding of the Managed Vision Care industry, including credentialing, eligibility verification, claims processing, and payment procedures.
  • Strong organizational and time management skills.
Benefits:

RTA US offers eligible employees a comprehensive benefits package that includes healthcare coverage (medical, dental, and vision), supplemental insurance options, a 401(k) retirement plan, life and disability insurance, an employee assistance program, identity theft protection, legal support, and discounts with select vendors.

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