Provider Credentialing Specialist

CareSource • New York, NY

3d

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. Essential Functions: 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.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 11-50 employees