Provider Credentialing Specialist (Hybrid)

CareSource Management Services•New York City, NY

9d•Hybrid

About The Position

The provider Credentialing Specialist is responsible for facilitating the centralized credentialing process for the company's providers, addressing all functions for initial and re-credentialing of Specialty Partners providers in accordance with departmental policies and procedures.

Requirements

High School or GED diploma required
Two (2) years experience with Medicare and Medicaid Provider Network Requirements required
Strong Data Analysis Experience
Proficient in Microsoft Word and Excel
Ability to absorb details accurately
Excellent organizational skills
Strong Interpersonal and Communication Skills
Attention to detail
Familiarity of the healthcare field
Knowledge of medical terminology
Knowledge of Medicaid & Medicare managed care
Critical listening and thinking skills
Uses proper grammar
Technical writing skills
Time management skills
Proper phone etiquette
Customer service orientated
Decision making/problem solving skills

Responsibilities

Collect and document provider credentials per credentialing and re-credentialing protocols, guidelines and policy/procedures.
Notify providers of new and additional credentialing requirements.
Maintain and update databases, including the provider database and directory.
Process rosters and updates from delegated providers.
Generate data reports as needed.
Assist with Provider Relations activities, including preparing required provider network data for submissions, reviewing submission results and preparing responses to network deficiencies.
Respond to staff and provider network inquiries.
Participate in department projects and provide support to the Department as needed, including review provider documents, including provider application, attestations, and credentials for processing provider contracts, letters of agreement, contract amendments, and notices.
Perform any other job related duties as requested.