Centers Health Care is looking for a Credentialing Coordinator to work out of our corporate offices in Bronx, NY.
Responsible for leading, coordinating, monitoring, and maintaining the credentialing and re-credentialing process. Facilitates all aspects of credentialing, ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws relating to credentialing.
Duties and Responsibilities
1. Leads, coordinates, and monitors the review and analysis of Skill Nursing facility applications and accompanying documents.
2. Prepares credentials file for completion and presentation to Health Plans, ensuring file completion within time periods specified.
3. Processes requests for privileges, ensuring compliance with criteria outlined in clinical privilege descriptions.
4. Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and privileging issues as they arise.
5. Assists with managed care delegated credentialing audits; conducts internal file audits.
6. Performs miscellaneous job-related duties as assigned.
Minimum Job Requirements
- High school diploma or College degree preferred at least 2 years of experience directly related to managed care credentialing.
- Completed degree(s) from an accredited institution preferred.
Knowledge, Skills and Abilities Required
- Ability to communicate effectively, both orally and in writing.
- Knowledge of related accreditation and certification requirements.
- Knowledge of managed care credentialing procedures and standards.
- Informational research skills.
- Ability to use independent judgment to manage confidential information.
- Database management skills including querying, reporting, and document generation.
- Ability to make administrative/procedural decisions and judgments.