Job Information
Healthfirst Senior Credentialing Specialist in Remote, New York
Duties/Responsibilities
The Senior Credentialing Specialist is responsible for the credentialing and recredentialing of Healthfirst non-delegated providers and vendors, facilities and groups and ensures credentialing and recredentialing documents and files are complete and accurate in accordance with Healthfirst Credentialing Policies and Procedures and NYS and CMS credentialing regulations.
Perform primary source verifications and query necessary databases including but not limited to the following: CAQH, NPDB, NSCH, ABMS, AOA, AMA, etc.
Troubleshoot issues and outreach to necessary internal and external contacts as required to obtain credentialing and recredentialing documents.
Actively participate with and support the development of internal provider systems used to intake, track and monitor provider credentialing.
Prepare, review and/or audit flagged/unclean files for presentation to the Credentialing Committee as applicable.
Develop job aids, workflows, and policies as procedures and systems evolve
Participate in internal and external meetings to respond to inquiries and define credentialing requirements for stakeholders.
Prepare bi-weekly clean file approval lists for medical directors
Additional duties/tasks as assigned
Minimum Qualifications
8+ years of credentialing experience
Bachelors degree or equivalent combination of education and experience
Proficiency in MS Word, Excel, Outlook
Superior organizational and follow up skills
Strong attention to detail
Preferred Qualifications
Excellent verbal and written communication skills.
Troubleshooting and conflict resolution skills; ability to escalate to leadership when necessary
Ability to train others on credentialing/recredentialing requirements.
File auditing experience
Proficiency in PowerPoint and OneNote
Compliance & Regulatory Responsibilities
The Senior Credentialing Specialist is responsible for the Credentialing and Recredentialing of Healthfirst providers and ensures that the credentialing documents and files are complete and accurate in accordance with Healthfirst Credentialing Policies and Procedures, and Federal and State Credentialing Regulations.
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.