Associate, Credentialing Specialist
Conducts verification of and processes credentialing and recredentialing applications of providers and organizational facilities in accordance with MVP Policies, NCQA standards, CMS, NYS Department of Health and other regulatory agencies. Processes Credentialing and Recredentialing Applications for practitioners and organizational providers including preparing files for the MVP Credentials Committee. Conducts primary source verifications from various sources (hospitals, residency programs, internet sources, physicians, practitioners, and insurance companies).Reviews files to ensure all necessary documentation and information has been received and conducts follow up, as necessary. Processes provider specialty/category change requests, ongoing monitoring files, early files, and staff review files. Data enters Credentialing information into Cactus Credentialing software and performs Cactus cleanup projects, as directed. Monitor and maintain outstanding record reports and noncompliance reports to ensure regulatory compliance. Liaison between IPAs, Professional Relations, Provider Data Management, Network Development and Credentialing department. Prepare documents for scanning, scan documents and then save into Macess. Ability to maintain confidentiality and adhere to regulatory compliance issues as they exist and change from time to time. Must be able to work additional hours as needed. Performs other duties as required.
Associate’s degree or relevant training in a business school/health care setting.
Minimum of 2 years of employment experience working in the medical community (medical office, medical records, medical billing), claims processing, health care or health insurance required.
Previous experience with Microsoft office programs and data entry required.
Previous credentialing experience strongly preferred.
Demonstrated working knowledge of medical terminology preferred.
Cactus Software experience preferred.
• Strong interpersonal, communication and organizational skills
• Ability to work independently, ability to handle multiple tasks at one time, ability to meet deadlines.
• Strict attention to detail.
• Ability to meet and maintain required departmental quality and quantity standards, ability to monitor and follow up on outstanding items identified.
• Ability to sit at a workstation for extended periods.
• Occasional ability to lift, carry and put away parcels up to 10 pounds.
- Job Family Quality Improvement
- Pay Type Hourly
- Headquarters Office, 625 State Street, Schenectady, New York, United States of America