Credentialing Specialist - Network Temp : Job Details

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