Credentialing Specialist 9/16/2016

Winston Staffing Services New York, NY

Company
Winston Staffing Services
Job Classification
Full Time
Company Ref #
winnyIK-CRED
AJE Ref #
576199048
Location
New York, NY
Job Type
Temporary

JOB DESCRIPTION

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This position for a healthcare insurance company in NYC ensures the timely and accurate credentialing of providers and maintains the provider database. Ensures the accuracy, timeliness of data entry, database functionality and reporting, and provider communications; and compliance with the various regulatory standards for managed care provider credentialing. This position is accountable for meeting specific credentialed file production goals. ESSENTIAL FUNCTIONSEssential functions are job duties and responsibilities that must be performed to accomplish the purpose/ goals of the job.?Conduct initial credentialing application reviews and summarize results for Medical Director?s review. Ensure compliance with National Committee for Quality Assurance (NCQA) credentialing standards, including timelines. Completes the required number of credentialing files each day.?Maintain provider database and ensure the timely and accurate submission of data and reporting for provider correspondence, the Plan's Information Services Department, Management Service Organization (MSO), and other appropriate usage.?Act as liaison between the Plan and providers regarding credentialing and re-credentialing activities in consultation with the Medical Director.?Maintain provider credentialing files in compliance with regulatory standards.OTHER RESPONSIBILITIESInclude other significant responsibilities needed to accomplish job purpose/goals that are performed on a daily or infrequent basis. ?Main

Requirements

This position for a healthcare insurance company in NYC ensures the timely
and accurate credentialing of providers and maintains the provider database.
Ensures the accuracy, timeliness of data entry, database functionality
and reporting, and provider communications; and compliance with the various
regulatory standards for managed care provider credentialing. This position
is accountable for meeting specific credentialed file production goals.
ESSENTIAL FUNCTIONSEssential functions are job duties and responsibilities
that must be performed to accomplish the purpose/ goals of the job.?Conduct
initial credentialing application reviews and summarize results for Medical
Director?s review. Ensure compliance with National Committee for Quality
Assurance (NCQA) credentialing standards, including timelines. Completes
the required number of credentialing files each day.?Maintain provider
database and ensure the timely and accurate submission of data and reporting
for provider correspondence, the Plan's Information Services Department,
Management Service Organization (MSO), and other appropriate usage.?Act
as liaison between the Plan and providers regarding credentialing and re-credentialing
activities in consultation with the Medical Director.?Maintain provider
credentialing files in compliance with regulatory standards.OTHER RESPONSIBILITIESInclude
other significant responsibilities needed to accomplish job purpose/goals
that are performed on a daily or infrequent basis. ?Main

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http://www.net-temps.com/job/t9m8/IK-CRED/credentialing_specialist.html?r=aje

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