• Credentialing Associate

    Location US-NY-New York
    Posted Date 1 week ago(1 week ago)
    Job ID
    2018-12173
    # Positions
    1
    Facility
    ArchCare Community Services
    Experience (Years)
    2
    Category
    Administrative
    Work Days Per Week
    5
    Shift
    D
    Shift Start Time
    9:00 AM
    Shift End Time
    5:00 PM
    Type
    Full-Time
    # Hours
    35.0
  • Overview

    Credentialing Associate assumes the responsibility of receiving, verifying and processing submitted credentialing documentation for all practitioners and ancillary providers who provide services to ArchCare Advantage, Senior Life and Community Life members.

    Responsibilities

    • Ensure completeness of all applications and documentation submitted for ArchCare Advantage, Senior Life and Community Life for credentialing and re-credentialing.
    • Download applications and documentation from the CAQH website for initial and recredentialing of providers for ArchCare Advantage, Senior Life and Community Life providers.
    • Scan and email all applications and documentations to our credentials verification organization.
    • Act as liaison to vendor conducting primary source verification and ensure timely processing of applications for committee presentation. Perform daily review of vendor website to retrieve results of primary source verification.
    • Conduct monthly oversight of credentials verification organization activities, document activity and report results to the Delegation oversight committee.
    • Ensure compliance with all ArchCare, CMS, and NCQA credentialing and re-credentialing standards and regulations
    • Data entry into credentialing database of any changes, updates or terminations
    • Conduct outreach to physician/provider practices and ancillary providers to gather missing application documentation when needed (Daily).
    • Perform data entry of all applications received and enter dates when verifications are completed.
    • Coordinate with Provider Relations to ensure completeness of applications and timely processing of credentialing applications and notifications to Providers.
    • Prepare documentation for providers and vendors who will be presented to the (CPRS) Credentialing and Peer Review Subcommittee. Assist the Credentialing Manager with Agenda, Minutes, Provider Summary, distribution lists, etc. for ArchCare Advantage, Senior Life and Community Life.
    • Answer requests for status of applications from provider offices and internal queries.
    • Adhere to privacy and confidentiality and proprietary company policies and procedures (i.e. HIPAA).
    • Send out recredentialing applications and follow-up to providers and vendors
    • Work with Human Resources to obtain credentialing application and documentation from new employee medical personnel.
    • Scan all credentialing/recredentialing files and maintain paper and electronic files.
    • Generate monthly, weekly or quarterly reports from in-house or vendor owned provider data bases as necessary and any ad-hoc reports as requested.
    • Participate in any/all training and educational activities necessary to fulfill at least the minimum requirements as specified within the departmental goals.
    • Special projects and other duties as needed.

    Qualifications

    Formal Education: Associate’s Degree

    • 1-3 years relevant experiencec in credentialing; working with vendors
    • Proficient in Microsoft Windows including Excel, Word, and Access applications. Proficiency in Data Entry
    • Strong organizational and time management skills.
    • Ability to self-manage.
    • Good oral and written communication skills Strong problem solving techniques.
    • System troubleshooting ability a plus Ability to work collaboratively in a team environment Detailed oriented

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