Credentialing Coordinator

Shift - 9-5 Hybrid 2 days on-site (Thursdays Mandatory)
Pay - $25/hr. - $30/hr.

Client is committed to empowering New Yorkers by uniting communities through care. We believe that health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

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Position: Credentialing Coordinator

The Credentialing Coordinator is responsible for credentialing of new providers (including Behavioral Health providers & facilities), re-credentialing, and processing provider demographic updates and changes. The role involves document collection, review, verification, provider credentialing file maintenance, and ensuring that all credentialing supporting documentation is confidential and secure. Additionally, the Credentialing Coordinator assists facilities and providers in understanding and adhering to Clients policies and procedures regarding the credentialing process and provider information updates.

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Product of Role & Responsibilities

• Maintain communication with credentialing contacts at facilities and provider sites to coordinate receipt of information required for credentialing, re-credentialing, and provider updates.

• Review provider credentialing/re-credentialing files for completion and prepare them for presentation to the Credentialing Committee.

• Perform primary source verification in accordance with regulatory guidelines and policies.

• Data entry and upkeep of provider information in credentialing and other databases.

• Verify New York State OProduct, Medicare/Medicaid lists, and other databases for sanctions, restrictions, or limitations on credentialed providers.

• Verify New York State license registration and DEA registration status during interim credentialing periods.

• Generate and distribute monthly provider credentialing updates to appropriate departments and facilities.

• Review and respond to credentialing information requests within .

• Generate and disseminate provider rosters to delegated facilities and contracted group practices.

• Perform provider roster reconciliation.

• Create, copy, file, and maintain documentation in provider credentialing folders.

• Maintain confidentiality of provider credentials by securing credentialing files.

• Perform annual delegated file audits and participate in site reviews (pre-delegation and delegation).

• Respond to inquiries from departments regarding provider credentialing status.

• Perform other related tasks as directed by the Deputy Chief Operating Officer, Credentialing Director, or Team Lead.

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Required Education, Training & Professional Experience

• High School Degree required; Bachelor s Degree preferred.

• Minimum 2 years of experience with provider credentialing processes and procedures.

• Knowledge of CACTUS preferred.

• Ability to handle multiple projects simultaneously.

• Comprehensive knowledge of managed care, with emphasis on physician credentialing.

• Ability to meet time-sensitive deadlines and multitask in a changing healthcare environment.

• Understanding of credentialing activities related to initial credentialing, re-credentialing, and credential modifications.

Schedule Notes:
9-5 Hybrid 2 days on-site (Thursdays Mandatory) 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 OProduct, Medicare/Medicaid lists and other pertinent databases for any current sanctions, restrictions on licensure and/or limitations on the Product 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 at
and participating facilities and provider groups
Review and respond to request for credentialing information/copies of credentialing files to appropriate departments within 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

Schedule Days Per Week:
5.00