Credentialing Coordinator

5 days ago


New York, New York, United States Russell Tobin Full time
Credentialing Coordinator Job Description

Russell Tobin is seeking a skilled Credentialing Coordinator to join their team in New York, NY. As a Credentialing Coordinator, you will play a crucial role in administering the credentialing and re-credentialing processes for healthcare providers.

Key Responsibilities:
  • Support the overall provider credentialing and re-credentialing processes while maintaining standard turn-around times.
  • Ensure credentialing files and re-credentialing files are started on time and continue in the process according to standards.
  • Monitor participating provider network for credentialing/re-credentialing deficiencies and take necessary action per the policies and procedures.
  • Terminate providers who do not comply with the credentialing standards.
  • Prepare and execute outbound communications related to the credentialing events.
  • Research discrepancies related to provider information.
  • Support the preparation of weekly rosters to present providers for committee approvals/denials.
  • Support credentialing audits by pulling files and preparing the files for presentation to external clients.
  • Obtain missing information from various sources including the provider to ensure provider maintains compliance with EyeMed Network.
  • Execute reports to review and make necessary updates to provider information and provide status to management.
  • Prepare reports of status on credentialing activities.
Requirements:
  • High School Diploma
  • 2-3 years business experience with healthcare provider credentialing
  • Proficient in Microsoft Office Products (Word, Excel, Access)
  • Ability to work well independently, under pressure and multi-tasking
  • Ability to successfully work on multiple projects simultaneously while managing time effectively
Nice to Have:
  • Associate or bachelor's Degree
  • Knowledge of credentialing/provider industry
  • Demonstrates sense of urgency
  • Experience with operating systems such as EDW/Business Objects
  • 1-3 years' experience in healthcare with a focus on credentialing operations.
  • A clear understanding and ongoing knowledge of changes in the Managed Vision Care industry including credentialing, eligibility checking, claims filing and payment receipt.
  • Strong organizational skills, and time management.
Benefits:

Russell Tobin offers eligible employee's comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), a 401(k)-retirement savings, life & disability insurance, an employee assistance program, identity theft protection, legal support, auto and home insurance, pet insurance, and employee discounts with some preferred vendors.



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