Job Description

Job Type Contract Description Scope of Role & Responsibilities • Maintain communication with the credentialing contacts at facilities and provider sites to coordinate receipt of information required for credentialing, re-credentialing, and update of provider credentialing information • Review provider re-credentialing and credentialing file for completion and presentation to the Credentialing Committee. • Perform primary source verification on required elements and in accordance regulatory guidelines and policies and procedures

• Data entry and upkeep of provider information in the credentialing and other pertinent databases
• Verify New York State OPMC, Medicare/Medicaid lists and other pertinent databases for any current

sanctions, restrictions on licensure and/or limitations on the scope of practice on all credentialed providers in interim credentialing periods • Verify New York State license registration and DEA registration status for all credentialed providers in the interim credentialing periods

• Generate and disseminate monthly provider credentialing updates to appropriate departments and participating facilities and provider groups
• Review and respond to request for credentialing information/copies of credentialing files to appropriate

departments

• Generate and disseminate provider rosters to delegated facilities, contracted group practices etc.
• Perform provider roster reconciliation
• Create, copy, file, and maintain all relevant documentation into provider credentialing folder.
• Maintain confidentiality of provider credentials by filing the credentialing folder in respective cabinets in

the file rooms.

• Perform annual delegated file audits and participate in pre-delegation and delegation site reviews
• Respond to inquiries from other departments relative to a provider's credentialing status
• Performs other related tasks as directed by the Deputy Chief Operating Officer or her designee, the

Credentialing Director or Credentialing Team Lead. Required Education, Training & Professional Experience

• High school Degree required; Bachelor's Degree preferred
• 2 years of previous experience with provider credentialing processes and procedures
• Knowledge of CACTUS or MD-Staff preferred
• Must be able to handle multiple projects simultaneously.
• Comprehensive knowledge of managed care with a specific emphasis on physician credentialing.
• Ability to meet time-sensitive deadlines and multi-task in a changing healthcare environment.
• Understanding of credentialing activities as they relate to initial credentialing, re-credentialing, and

credentials modification(s). Salary Description 32 an hour Network Temp Inc

Job Tags

Contract work, Temporary work, Interim role,

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