Credentialing Specialist Credentialing Specialist - White Plains, NY, United States - Jobot

Description

Credentialing Specialist role with low-cost medical coverage, generous paid time off and 403B Retirement plan with company match

This Jobot Job is hosted by: A trailblazing fertility and family-building solutions medical benefits organization with over 25 years of success, has proudly supported over 500,000 families on the path to parenthood.

To meet the evolving needs of today's families, our organization is proud of our long-standing legacy in fertility and family well-being services, expanding offerings from pre-conception and fertility to parenting, healthy aging, and beyond.

We have dramatically improved patient experience through a new and cutting-edge digital interface, customized to each patient's journey, and expanded services designed to support the physical, emotional, and social health and happiness

We are the largest, most experienced fertility benefit management company in the country offering inclusive family-building solutions to employers, health plans and individual patients.

From integrated fertility management, including medical treatment, pharmacy, and reproductive genetics, to surrogacy and adoption, our mission is to help build families by providing access to the best network of doctors, technology and emotional support at the lowest cost.

Our programs include an integrated medical and pharmaceutical model that is unique to the industry.

Its dedicated nurse care managers, all with experience in reproductive endocrinology clinics, guide employees through every step of their fertility journey, and are available 24/7.

Dental Coverage thru Guardian
~9 company paid holidays.
~401K Retirement plan with Company match
~Short term and long-term care coverage
~Flex spending account
~Health Savings Account

We are looking to hire a full-time Credentialing Specialist who will report directly to the VP of Network Development and Contracting.

As the Credentialing Specialist, you MUST have at least Two (2) years' experience with Provider credentialing protocols, resources, process and regulatory requirements as well as two (2) years administrative experience supporting mid to high level management in a corporate environment and be able to utilize Microsoft Office Suite including: Word, Excel, PowerPoint, and Adobe Acrobat

In this rewarding role, you will be responsible for assuring that all provider credentialing is completed and maintained per company Policies & Procedures, state regulatory requirements, accreditation requirements and contracted health plan directives.

Assumes responsibility for licensure primary source verification for all UM team (physicians and nurses) per company policies & Procedures and maintains spreadsheet and documentation of PSV verifications

• Conduct initial Credentialing for onboarding Providers
• Prepare and maintain reports of credentialing activities for Provider'saccreditation,a liated insurancesauditsandemploymentstatus
• Screening practitioners applications and supporting documentation to ascertain their eligibility
• Maintain necessary logs,lists,records, and current documentation required for provider credentialing and de-credentialing with the use of excel, and Outlook
• Monitor and coordinate copies of current state licenses, DEA certificates ,malpractice coverage and any other required credentialing documents for all providers with the use of state websites
• Maintain and coordinate Provider's CAQH accounts
• Conduct initial enrollment is Provider's NPI number with the use of NPPES/CM Swebsite Patient Care Coordinator

~Coordinates and executes all credentialing activities per company Policies & Procedures
~Ensure that Providers contacted receive prompt attention to their application and that credentialing protocols are followed in a timely manner
~Ensure that all Provider information is entered and maintained in company's Provider Database
~Prepares and maintains credentialing files for review by internal staff or external clients
~Assist with credentialing audits as needed and directed by management