"Enrollment and Credentialing Specialist"

Enrollment and Credentialing Specialist

Title: Enrollment and Credentialing Specialist

Location: Midtown

Org Unit: Enrollment

Weekly Hours: 35.00

Exemption Status: Non-Exempt

Salary Range: $29.34 - $32.64
*As required under NYC Human Rights Law Int 1208-2018 - Salary range for this role when Hired for NYC Offices

Position Summary

Under the direct supervision of the MCO Enrollment & Credentialing Team the Enrollment and Credentialing Specialist is primarily responsible for the management of all incoming & outgoing correspondence and paper credentialing applications. As directed, will manage data related to physician enrollment into Government plans for full time faculty.

Job Responsibilities

• Manage the retrieval, sorting, scanning, and organizing of received correspondence for the Managed Care Office.
• Oversee, review, mail, scan, and diligently track outgoing applications pertaining to physician enrollment, recertification, and revalidation into Government payers for full-time faculty.
• Evaluate reports to identify data disparities between group contracted plan sources and Managed Care database to limit negative impact on revenue, precertification, referral denials and patient procedure cancellations.
• Collaborate with plan representatives to follow up on the status of enrollment applications and rectify errors.
• Maintain individual physician and departmental files according to credentialing policies and procedures with initial and recredential applications and credential verifications, as directed by the supervisor.
• Maintain the internal database and external web module database, updating physician info in Medicare, Medicaid, and non-contracted carriers. This includes approval info, demographic details, address changes, and disenrollment, as directed by the supv.
• Process enrollment applications, accurately enter data, and adhere to credentialing policies and procedures as directed by the supervisor.
• Perform related duties as assigned.

Education

High School Diploma

Experience

One or more years of related experience in health care and/or practice management.

Knowledge, Skills and Abilities

Proficient computer skills, including previous experience with Microsoft Word, Outlook, and Excel (e.g., creating spreadsheets, inserting/deleting/manipulating/saving data, data sorting/filtering for plan-database comparisons and reconciliations).

Working Conditions/Physical Demands

Full-time on-site