Credentialing Specialist

3 weeks ago

New York, New York, United States Russell Tobin & Associates Full time



Overview of the Credentialing Coordinator Role

Russell Tobin & Associates is collaborating with a prominent Italian eyewear brand to find a Credentialing Coordinator.

The Credentialing Coordinator acts as a key resource in managing the credentialing and re-credentialing processes within the organization.

Position Details:

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 workflows while adhering to established turnaround times.
  • Ensures timely initiation and progression of credentialing and re-credentialing files in accordance with organizational standards.
  • Monitors the provider network for any credentialing or re-credentialing deficiencies and takes appropriate actions as per established policies.
  • Handles the termination of providers who fail to meet credentialing standards.
  • Prepares and manages outbound communications related to credentialing activities.
  • Investigates discrepancies in provider information to maintain accuracy.
  • Assists in the preparation of weekly rosters for committee review and decision-making.
  • Supports credentialing audits by organizing files for presentation to external stakeholders.
  • Collects missing information from various sources to ensure compliance with the EyeMed Network.
  • Generates reports to review and update provider information, providing status updates to management.
  • Compiles reports detailing the status of credentialing activities.

Qualifications:

  • High School Diploma or equivalent.
  • 2-3 years of experience in business, specifically in healthcare provider credentialing.
  • Proficient in Microsoft Office Suite (Word, Excel, Access).
  • Ability to work independently, manage pressure, and multitask effectively.
  • Capable of handling multiple projects simultaneously while effectively managing time.

Preferred Qualifications:

  • Associate or Bachelor's Degree.
  • Familiarity with the credentialing and provider industry.
  • Demonstrates a strong sense of urgency.
  • 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 receipt.
  • Strong organizational and time management skills.

Benefits Offered by Russell Tobin:

Russell Tobin provides eligible employees with extensive healthcare coverage, including medical, dental, and vision plans, as well as supplemental coverage options. Additional benefits include a 401(k) retirement plan, life and disability insurance, an employee assistance program, identity theft protection, legal support, auto and home insurance, pet insurance, and employee discounts with select vendors.

#CB

Compensation: $20-$24/hr, based on experience

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