Credentialing Coordinator

Credentialing Coordinator

  Not Disclosed

  New York , NY

  6.0 Months

  Not Disclosed

  Not Disclosed

  Services

  $20.93/hour - $25.93/hour

Job Description

Description/Comment:

Credentialing Coordinator

GENERAL FUNCTION

The Credentialing Coordinator serves as one of the main resources to administer the credentialing and re-credentialing activities with the team. Ensures all client providers meet the credentialing requirements for participation.

MAJOR DUTIES AND RESPONSIBILITIES
Supports the overall provider credentialing and re-credentialing processes while maintaining standard turn-around times
Responsible to ensure the credentialing files and re-credentialing files are started on time and continue in the process according to standards.
Monitors participating provider network for credentialing/re-credentialing deficiencies and takes necessary action per the policies and procedures.
Terminates providers who do not comply with the credentialing standards.
Prepares and executes outbound communications related to the credentialing events.
Researches discrepancies related to provider information.
Supports the preparation of weekly rosters to present providers for committee approvals/denials
Supports credentialing audits by pulling files and preparing the files for presentation to external clients.
Obtains missing information from various sources including the provider to ensure provider maintains compliance with client Network
Executes reports to review and make necessary updates to provider information and provide status to management
Prepare reports of status on credentialing activities

BASIC QUALIFICATIONS
High School Diploma
2-3 years business experience with healthcare provider credentialing
Proficient in Microsoft Office Products (Word, Excel, Access)
Excellent communication skills (written/verbal)
Ability to work well independently, under pressure and multi-tasking
Ability to successfully work on multiple projects simultaneously while managing time effectively

PREFERRED QUALIFICATIONS
Associate or Bachelor’s Degree
Knowledge of credentialing/provider industry
Demonstrates sense of urgency
Experience with operating systems such as EDW/Business Objects

Additional Job Details:
Specific Skills Needed:
Top 3-5 mandatory and/or minimum requirements

Assists with managing the credentialing process and partners with doctors to ensure all paperwork is complete, accurate and accounted for including insurance applications, and internal paperwork for either employed or sublease doctors.
Sources information from various internal databases to complete as many of the business applications as possible. Identifies missing or inaccurate data and researches the best solution, confirming accuracy including updating all applicable databases with relevant information for credentialing and insurance contracting.
Assists in uncovering and resolving doctor credentialing questions and/or issues and recommends and creates program enhancements to better the doctor’s experience.

Top 3-5 desirable attributes/qualifications
1-3 years’ experience in healthcare with a focus on credentialing operations.
A clear understanding and ongoing knowledge of changes in the Managed Vision Care industry including credentialing, eligibility checking, claims filing and payment receipt.
Strong organizational skills, and time management.


Note:
Hybrid ( NYC, preferably Tuesdays & Wednesdays but negotiable at least one of those days)
Hours: 8:00am to 5:00pm
VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status