Credentialing Specialist - Part Time

Project Renewal is a leading non-profit organization with the mission of building supportive communities where people achieve dignity and independence. They are seeking a Credentialing Specialist responsible for maintaining the accuracy and integrity of the enrollment, credentialing, and re-credentialing of Providers and PRI facilities with third party payers.

Responsibilities

• Responsible for all credentialing processes related to compliance, regulations and billable services
• Provide initial and reappointment applications to providers for Medicare, Medicaid, commercial and Managed Care Plans
• Responsible for adding and removing providers to / from insurance panels
• Review application packages and work with Providers and healthcare department leadership to ensure accuracy of provider identifying information, education, training, certifications, professional affiliations, licensing, claims history and work history
• Search databases for medical malpractice claims, National Provider Information, and for Medicare/Medicaid and other sanctions
• Assemble peer review letters, proof of continuing education and health clearance
• Monitors files to ensure completeness and accuracy and reviews all file documentation for compliance with quality standards, accreditation requirements and all other relevant policies
• Maintain accurate department database for providers
• Provide updated information to managed care companies to support the organization’s delegated credentialing status
• Prepare for and handle audits by managed care companies
• Provide credentialing verification to other institutions upon request and release from current or past medical staff members
• Provides routine reports to Providers and support staff regarding the status of participation in insurance plans
• Provides updates regarding managed care plan credentialing procedure changes and other relevant information
• Produces management reports regarding operations performance and/or provider credentialing status for internal management and external providers using the organization’s verification services
• Develops and disseminates credentialing policy and procedures ensuring adherence to legal requirements and best practices
• Adheres to operating policies and procedures including delivery of completed work and use of resources
• Initiates correspondence to providers, users, health plans and others as necessary to obtain requisite credentialing information
• Inform management regarding the status of departmental operations and provider credentialing issues of concern
• Communicate clearly with Providers, healthcare leadership and administrative staff as needed to provide timely responses upon request on day-to-day credentialing issues as they arise
• Additional tasks as needed and directed

Preferred

• Bachelor's degree preferred
• Certified Provider Credentialing Specialist (CPCS) certification preferred
• Familiarity with Microsoft Office applications, desirable
• Bachelor's degree
• CPCS certification
• Microsoft Office proficiency

Company

• Nonprofit providing housing, healthcare, and jobs for homeless New Yorkers
• New York, New York, USA
• https://www.projectrenewal.org/
• Founded in 1967
• 501-1000 employees

Qualifications

• Minimum of two (2) years of credentialing experience in a hospital/community health center setting
• Must be proficient with PECOS, CAQH, NPPES as well as the credentialing and re-credentialing process
• Computer database skills and word-processing required
• Excellent time management, organizational, and customer service skills
• High degree of organizational skills
• Excellent written and verbal communication skills
• Capable of building strong customer relationships and delivering customer-centric service to internal/external colleagues and candidates for appointments
• A good decision-maker, with proven success at making timely decisions that keep the organization moving forward
• Adept at planning and prioritizing work to meet deadlines in a fast-paced environment
• Consistently achieving results, even under time sensitive conditions
• An effective communicator, capable of determining how best to reach different audiences and executing communications based on that understanding
• Bachelor's degree preferred
• Certified Provider Credentialing Specialist (CPCS) certification preferred
• Familiarity with Microsoft Office applications, desirable

Required skills

• CAQH, Certified Provider Credentialing Specialist (CPCS), Credentialing Process, NPPES, PECOS

Preferred skills

• $1.66M, (2), *2024, 100, 116-unit supportive housing building to open in Bedford Park, 2023-02-15, 2025-10-07, Bachelor's degree preferred, Crain's New York Business, Data Powered by, Distribution of Different Job Fields Receiving Sponsorship, Eric Rosenbaum, Familiarity with Microsoft Office applications, desirable, Grant· $1.66M, H1B Sponsorship, Human Resources, Key Investors, Late Stage, Leadership Team, Mitchell Netburn, New York State, New York, New York, USA, President & CEO, President and CEO, Recent News, Represents job field similar to this job, The awards will help fund 127 projects throughout the state., Total Funding, Trends of Total Sponsorships, https://www.projectrenewal.org/

Experience

• 2+ years