Job Description
Job Type
Contract
Description
Scope of Role & Responsibilities
• Maintain communication with the credentialing contacts at facilities and provider sites to coordinate receipt
of information required for credentialing, re-credentialing, and update of provider credentialing information
• Review provider re-credentialing and credentialing file for completion and presentation to the Credentialing
Committee.
• Perform primary source verification on required elements and in accordance regulatory guidelines and
policies and procedures
- Data entry and upkeep of provider information in the credentialing and other pertinent databases
- Verify New York State OPMC, Medicare/Medicaid lists and other pertinent databases for any current
sanctions, restrictions on licensure and/or limitations on the scope of practice on all credentialed providers
in interim credentialing periods
• Verify New York State license registration and DEA registration status for all credentialed providers in the
interim credentialing periods
- Generate and disseminate monthly provider credentialing updates to appropriate departments and participating facilities and provider groups
- Review and respond to request for credentialing information/copies of credentialing files to appropriate
departments
- Generate and disseminate provider rosters to delegated facilities, contracted group practices etc.
- Perform provider roster reconciliation
- Create, copy, file, and maintain all relevant documentation into provider credentialing folder.
- Maintain confidentiality of provider credentials by filing the credentialing folder in respective cabinets in
the file rooms.
- Perform annual delegated file audits and participate in pre-delegation and delegation site reviews
- Respond to inquiries from other departments relative to a provider's credentialing status
- Performs other related tasks as directed by the Deputy Chief Operating Officer or her designee, the
Credentialing Director or Credentialing Team Lead.
Required Education, Training & Professional Experience
- High school Degree required; Bachelor's Degree preferred
- 2 years of previous experience with provider credentialing processes and procedures
- Knowledge of CACTUS or MD-Staff preferred
- Must be able to handle multiple projects simultaneously.
- Comprehensive knowledge of managed care with a specific emphasis on physician credentialing.
- Ability to meet time-sensitive deadlines and multi-task in a changing healthcare environment.
- Understanding of credentialing activities as they relate to initial credentialing, re-credentialing, and
credentials modification(s).
Salary Description
32 an hour Network Temp Inc
Job Tags
Contract work, Temporary work, Interim role,