Provider Credentialing Specialist (Hybrid) - R12473
CareSource, New York, NY, United States
ElderServe Health is a mission-driven, nonprofit managed care organization serving the New York metropolitan area. ElderServe provides long-term services and supports to more than 20,000 older adults and adults with disabilities across New York City, as well as Westchester, Nassau, and Suffolk Counties. ElderServe primarily serves a frail and elderly membership who is predominantly dual-eligible and enrolled in Medicaid managed long-term care, Medicare-only and integrated Medicaid-Medicare plans. ElderServe's affiliation addresses these critical long-term care needs to help members be as healthy and independent as possible.
Job Summary The provider Credentialing Specialist is responsible for facilitating the centralized credentialing process for the company's providers, addressing all functions for initial and re-credentialing of Specialty Partners providers in accordance with departmental policies and procedures.
Essential Functions
Collect and document provider credentials per credentialing and re-credentialing protocols, guidelines and policy/procedures.
Notify providers of new and additional credentialing requirements.
Maintain and update databases, including the provider database and directory.
Process rosters and updates from delegated providers.
Generate data reports as needed.
Assist with Provider Relations activities, including preparing required provider network data for submissions, reviewing submission results and preparing responses to network deficiencies.
Respond to staff and provider network inquiries.
Participate in department projects and provide support to the Department as needed, including review provider documents, including provider application, attestations, and credentials for processing provider contracts, letters of agreement, contract amendments, and notices.
Perform any other job related duties as requested.
Education And Experience
High School or GED diploma required
Two (2) years experience with Medicare and Medicaid Provider Network Requirements required
Competencies, Knowledge And Skills
Strong Data Analysis Experience
Proficient in Microsoft Word and Excel
Ability to absorb details accurately
Excellent organizational skills
Strong Interpersonal and Communication Skills
Attention to detail
Familiarity of the healthcare field
Knowledge of medical terminology
Knowledge of Medicaid & Medicare managed care
Critical listening and thinking skills
Uses proper grammar
Technical writing skills
Time management skills
Proper phone etiquette
Customer service orientated
Decision making/problem solving skills
Licensure And Certification
None
Working Conditions
General office environment; may be required to sit or stand for extended periods of time
Travel is not typically required
Compensation Range $47,400.00 - $76,000.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type Hourly
Competencies
Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
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Job Summary The provider Credentialing Specialist is responsible for facilitating the centralized credentialing process for the company's providers, addressing all functions for initial and re-credentialing of Specialty Partners providers in accordance with departmental policies and procedures.
Essential Functions
Collect and document provider credentials per credentialing and re-credentialing protocols, guidelines and policy/procedures.
Notify providers of new and additional credentialing requirements.
Maintain and update databases, including the provider database and directory.
Process rosters and updates from delegated providers.
Generate data reports as needed.
Assist with Provider Relations activities, including preparing required provider network data for submissions, reviewing submission results and preparing responses to network deficiencies.
Respond to staff and provider network inquiries.
Participate in department projects and provide support to the Department as needed, including review provider documents, including provider application, attestations, and credentials for processing provider contracts, letters of agreement, contract amendments, and notices.
Perform any other job related duties as requested.
Education And Experience
High School or GED diploma required
Two (2) years experience with Medicare and Medicaid Provider Network Requirements required
Competencies, Knowledge And Skills
Strong Data Analysis Experience
Proficient in Microsoft Word and Excel
Ability to absorb details accurately
Excellent organizational skills
Strong Interpersonal and Communication Skills
Attention to detail
Familiarity of the healthcare field
Knowledge of medical terminology
Knowledge of Medicaid & Medicare managed care
Critical listening and thinking skills
Uses proper grammar
Technical writing skills
Time management skills
Proper phone etiquette
Customer service orientated
Decision making/problem solving skills
Licensure And Certification
None
Working Conditions
General office environment; may be required to sit or stand for extended periods of time
Travel is not typically required
Compensation Range $47,400.00 - $76,000.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type Hourly
Competencies
Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
#J-18808-Ljbffr