Sr Credentialing Specialist (Temp)

HealthFirst

7d•$61,300 - $99,620

About The Position

The Senior Credentialing Specialist is responsible for the credentialing and recredentialing of Healthfirst non-delegated providers and vendors, facilities and groups and ensures credentialing and recredentialing documents and files are complete and accurate in accordance with Healthfirst Credentialing Policies and Procedures and NYS and CMS credentialing regulations. Duties/Responsibilities Perform primary source verifications and query necessary databases including but not limited to the following: CAQH, NPDB, NSCH, ABMS, AOA, AMA, etc. Perform credentialing and recredentialing of non-delegated providers and vendors, facilities and groups in accordance with established credentialing policies and procedures and NYS and CMS credentialing regulations. Work collaboratively with Vendor Management Specialist and designated Credentialing Verifications Organization (CVO) and audit monthly files. Prepare, review, update and/or audit committee summaries and present them to the Credentialing Committee as applicable. Participate in internal and external meetings to respond to inquiries and define credentialing requirements for stakeholders. Troubleshoot issues and outreach to necessary internal and external contacts as required to obtain credentialing and recredentialing documents. Actively participate with and support the development of internal provider systems used to intake, track and monitor provider credentialing. Develop job aids, workflows, and policies as procedures and systems evolve Participate in internal and external meetings to respond to inquiries and define credentialing requirements for stakeholders. Prepare bi-weekly clean file approval lists for medical directors Additional duties/tasks as assigned

Requirements

5+ years of proven credentialing experience
Facilities experience
Bachelor’s degree or equivalent combination of education and experience
Proficiency in MS Word, Excel, Outlook
Superior organizational and follow up skills
Strong attention to detail

Nice To Haves

Excellent verbal and written communication skills.
Troubleshooting and conflict resolution skills; ability to escalate to leadership when necessary
Ability to train others on credentialing/recredentialing requirements.
File auditing experience
Proficiency in PowerPoint and OneNote

Responsibilities

Perform primary source verifications and query necessary databases including but not limited to the following: CAQH, NPDB, NSCH, ABMS, AOA, AMA, etc.
Perform credentialing and recredentialing of non-delegated providers and vendors, facilities and groups in accordance with established credentialing policies and procedures and NYS and CMS credentialing regulations.
Work collaboratively with Vendor Management Specialist and designated Credentialing Verifications Organization (CVO) and audit monthly files.
Prepare, review, update and/or audit committee summaries and present them to the Credentialing Committee as applicable.
Participate in internal and external meetings to respond to inquiries and define credentialing requirements for stakeholders.
Troubleshoot issues and outreach to necessary internal and external contacts as required to obtain credentialing and recredentialing documents.
Actively participate with and support the development of internal provider systems used to intake, track and monitor provider credentialing.
Develop job aids, workflows, and policies as procedures and systems evolve
Prepare bi-weekly clean file approval lists for medical directors
Additional duties/tasks as assigned