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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.
Job Responsibility:
Perform primary source verifications and query necessary databases including but not limited to the following: CAQH, NPDB, NSCH, ABMS, AOA, AMA, etc
Perform credentialing and recredentialing of non-delegated providers and vendors, facilities and groups in accordance with established credentialing policies and procedures and NYS and CMS credentialing regulations
Work collaboratively with Vendor Management Specialist and designated Credentialing Verifications Organization (CVO) and audit monthly files
Prepare, review, update and/or audit committee summaries and present them to the Credentialing Committee as applicable
Participate in internal and external meetings to respond to inquiries and define credentialing requirements for stakeholders
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
Develop job aids, workflows, and policies as procedures and systems evolve
Prepare bi-weekly clean file approval lists for medical directors
Additional duties/tasks as assigned
Requirements:
5+ years of proven credentialing experience
Facilities experience
Bachelor’s degree or equivalent combination of education and experience
Proficiency in MS Word, Excel, Outlook
Superior organizational and follow up skills
Strong attention to detail
Nice to have:
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