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