Credentialing Coordinator

Job Description :

Description / Comment :

1 Role - Credentialing Coordinator

Brand : Shared Services - RONA

Start : ASAP

Duration : up to 6 months (potential temp to hire for right candidate) - MUST COMPLETE BACKGROUND CHECK AND STATE SCREENINGS / TRAINING

Location : NY - Hybrid ( NYC, preferably Tuesdays & Wednesdays but negotiable at least one of those days)

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 EyeMed 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 EyeMed 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

There will actually be 5 courses that required for all temporary employees :

3 for Compliance purposes and 2 for HiTrust / Security requirements :

1. General Compliance

2. HIPAA

3. Fraud, Waste, and Abuse

4. Security Essentials

5. Introduction to Phishing

In addition; Model of Care, ODAG, FSL Fraud Integral Staff training, CA Fair Claims.

Start Time : 12 : 00 AM

12 : 00 AM

Hours : 8 : 00am to 5 : 00pm

8 : 00am to 5 : 00pm

Location :

NY Office 1W37 One West 37th Street New York NY 10018

Education :

Additional Job Details :

Location : NY - Hybrid ( NYC, preferably Tuesdays & Wednesdays but negotiable at least one of those days) 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.