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2 CREDENTIALING SPECIALIST Jobs in Bronx, NY

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Somos Your Health, LLC
Bronx, NY | Full Time
$47k-59k (estimate)
0 Months Ago
Cirrus Healthcare
Bronx, NY | Full Time
$21-25 (estimate)
2 Months Ago
CREDENTIALING SPECIALIST
$47k-59k (estimate)
Full Time 0 Months Ago
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Somos Your Health, LLC is Hiring a CREDENTIALING SPECIALIST Near Bronx, NY

Job Description: Role and Responsibilities
Experienced credentialing specialist with the willingness to learn quickly in an adaptable start-up healthcare environment. Solid knowledge of Managed Care as well as credentialing standards. Ability to communicate inter-departmentally, as well as cross-departmentally on a daily/weekly basis.
Performs and coordinates credentialing delegation functions for contracted MCOs to maintain a quality provider network.
Serves as a liaison to the IPA to ensure current and adequate credentialing processes are in place.
Leads quarterly Credentialing Committee Meetings
Facilitates communication between Legacy IPA’s, TPA, and Health Plans
Monitors timelines of health plans
Interacts with health plan representative regarding enrollment audits; problems and claims resolutions; addressing potential corrective action plans and monitoring for successful resolution
Ensures all department policies and procedures are reviewed annually, updated as necessary, and remain in accordance with the State, CMS, or other regulatory requirements where applicable
Highly focused on the review of credentialing files and reporting to work with candidates and cross-functional teams to obtain missing, incomplete, and expiring items
COMPETENCIES AND QUALIFICATIONS
Associate’s or bachelor’s degree preferred
Minimum two years of experience managing credentialing, privileging, or similar healthcare professional verification and the organization's accreditation processes are required.
Minimum 1 year of experience in health plan enrollments and management is required
Familiar with NCQA Credentialing and re-credentialing standards
POSITION TPE AND EXPECTED HOURS OF WORK
Primary Location: 2910 Exterior Street, 1st Floor Bronx, NY 10463
Hours Per Week: 40
Shift: Day
Workdays: Mon, Tue, Wed, Thu, Fri
Working Hours: 40 hours per week
Job Schedule: Full-time - schedule to be determined by manager
Job Type: Standard
Employee Status: Regular
Employee Group/Union Affiliation: Salaried, Non-Union, Exempt
Job Level: Manager with Direct Reports
Job Category: External Affairs / Relations
Department: MSO Operations and Solutions
Travel: Yes, 5 % of the Time About SOMOS Innovation, LLC:
Employees and Board Members of SOMOS Innovation, LLC only access PHI/EPHI on a need-to-know basis. Employees and Board members may only access confidential information that is authorized within their scope of duties and responsibilities and is responsible for the safeguarding of this information. SOMOS may periodically review, revise and/or revoke an employee’s or Board member’s privileges to access confidential (PHI) information.
Please note this job description is not designed to cover or contain all activities, duties, or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Job Summary

JOB TYPE

Full Time

SALARY

$47k-59k (estimate)

POST DATE

03/21/2023

EXPIRATION DATE

03/24/2023

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Somos Your Health, LLC
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The job skills required for CREDENTIALING SPECIALIST include Managed Care, etc. Having related job skills and expertise will give you an advantage when applying to be a CREDENTIALING SPECIALIST. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by CREDENTIALING SPECIALIST. Select any job title you are interested in and start to search job requirements.

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The following is the career advancement route for CREDENTIALING SPECIALIST positions, which can be used as a reference in future career path planning. As a CREDENTIALING SPECIALIST, it can be promoted into senior positions as a Compliance Manager - Healthcare that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary CREDENTIALING SPECIALIST. You can explore the career advancement for a CREDENTIALING SPECIALIST below and select your interested title to get hiring information.

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If you are interested in becoming a Credentialing Specialist, you need to understand the job requirements and the detailed related responsibilities. Of course, a good educational background and an applicable major will also help in job hunting. Below are some tips on how to become a Credentialing Specialist for your reference.

Step 1: Understand the job description and responsibilities of an Accountant.

Quotes from people on Credentialing Specialist job description and responsibilities

A certified professional credentialing specialist ensures that staff members of a facility maintain licenses, training, and certifications based on federal and state law.

03/14/2022: Des Moines, IA

A credentialing specialist can have certificates that will prove useful to their field.

02/01/2022: Newark, NJ

Credentialing specialists also ensure that any services provided by medical facilities meet the required standards as set by state and federal government agencies.

02/21/2022: Evansville, IN

Credentialing specialists are part of an organization's administrative staff; they review medical policies, process contracts, and facilitate audit reports to validate that certified medical professionals comply with credentialing procedures.

02/01/2022: Las Cruces, NM

Credentialing specialists will also ensure that their employer meets state, federal and other regulations for quality of care.

01/18/2022: Pueblo, CO

Step 2: Knowing the best tips for becoming an Accountant can help you explore the needs of the position and prepare for the job-related knowledge well ahead of time.

Career tips from people on Credentialing Specialist jobs

Credentialing specialists can often find work with a high school diploma or the equivalent.

01/25/2022: Kingsport, TN

Some employers strongly prefer credentialing specialists who have a Certified Provider Credentialing Specialist (CPCS) credential.

03/01/2022: Parkersburg, WV

While an associate degree may not be required for a position as a credentialing specialist, some employers may prefer applicants with a two-year degree.

12/25/2021: Little Rock, AR

Make Use Of Advanced Software For Monitoring.

01/18/2022: New London, CT

Stay Updated with the Coalition for Affordable Quality Healthcare's Credentialing Program.

01/31/2022: Portsmouth, OH

Step 3: View the best colleges and universities for Credentialing Specialist.

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