Contracting and Credentialing Specialist Job Description

The Contracting & Credentialing Specialist will be responsible for submitting, tracking, and responding to group and individual provider credentialing and contracting. We are looking for an experienced Credentialing Specialist that has preferably worked in a Behavioral Health and Medical Healthcare environment. The ideal candidate will have a deep knowledge and history of working through payer processes and protocols and will have hands-on experience with submitting applications, tracking progress, and working with clinical staff to gather the information needed for both group and individual credentialing. Position reports to Director, Managed Care Contracts and Relationships.

Sends credentialing/insurance plans paperwork to incoming providers and re credentialing paperwork to existing providers -- Interborough and SLA, including any affiliates.
Assists as needed to ensure that provider credentialing/re-credentialing application is completed promptly and accurately. Accompanied by all required documentation including license, DEA, Board certifications etc.
Ensures that required documentations are kept up to date.
Submits appropriate demographic change forms to Health Plans, if applicable ∙ Creates and maintains accurate systems record, demographic updates, and terminations from health plans.
Serves as liaison between the providers including Medical Staff, Interborough, SLA and Health Plans. Proactively address any issues including missing documentation with providers
Attend and participate in Credentialing audits and Provider Relations meetings ∙ Manage and maintain Medicaid and Medicare enrollment process
Prepares status reports of work performed and next step
Participates in team-based problem solving activities and process improvements. ∙ Supports all other functions of the medical staff office and performs other duties as assigned by department leadership.

Requirements/Qualifications:

High School Diploma/GED required, BA Degree, preferred.
Working knowledge of Microsoft Office: Word and Excel
2+ Years of related work experience preferred
Exceptional organizational and interpersonal skills
Able to work both independently and collaboratively
Able to adapt to changes based on departmental needs
Excellent organizational, time management and attention to details skills, required.
Able to multitask in a fast-paced environment (organizational skills a must) – able to balance attention to detail and swift execution
Self-motivated and self-managed
Maintain high standards of confidentiality and professionalism at all times

Salary range: $30 - $32 per hour.

BENEFITS WE OFFER:

Medical including Dental and Vision
Cafeteria Plans: FSA, Dependent child care plan, qualified transportation plan
Up to 3% 401k Profit Sharing plan automatic contribution for eligible employees
401k Additional 4% match of your contribution from your salary
Employee Assistant Program Services (EAP)
Community Mental Health Loan Repayment Program for qualifying candidate
Paid time off (PTO)
Referral Bonus for qualifying positions

Interborough is an EEO employer and provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regards to race, color, religion, sex, national origin, disability status, genetics, protected veterans’ status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state and/or local law and encourage women, veterans and other minorities to apply.

Interborough Developmental and Consultation Center is committee to Diversity, Equity, Inclusion and Belonging (DEIB) in the workplace. We believe that DEIB is unite to every community.

Job Type: Full-time

Pay: $30.00 - $32.00 per hour

Expected hours: 40 per week

Benefits:

401(k)
401(k) matching
Dental insurance
Employee assistance program
Flexible spending account
Health insurance
Life insurance
Paid time off
Vision insurance

Schedule:

Monday to Friday
Weekends as needed

Experience:

Credentialing: 2 years (Required)
Microsoft Excel: 1 year (Required)

Ability to Commute:

Brooklyn, NY 11223 (Required)

Work Location: In person

SLA Associates, LLC dba IDCC Health Services

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