• Conducts market research across the country to locate appropriate specialties/providers needed for onsite medical services.
• Recruit and contract with providers for onsite medical services.
• Negotiates competitive reimbursement rates and reviews contract language.
• Establishes and maintains positive and productive relationships with providers.
• Educates network providers and staff to ensure efficient and effective implementation of specific workflow processes.
• Coordinates onsite training, required paperwork, and clearance requirements.
• Acts as liaison between correctional facilities and providers.
• Collects, reviews, and prepares data for final medical staff and allied health professionals credentials review for clinic, hospital and payer environments.
• Works with providers to obtain any missing information.
• Process requests for additions or changes in clinical privileges.
• Ensures that requisite licenses, malpractice coverage, and certifications are current for all medical staff members and allied health professionals.

Skills: Market Research, Provider Recruitment, Contract Negotiation, Relationship Management, Staff Training, Liaison Coordination, Data Credentialing, Compliance Management

• Maintains files on medical and allied health professionals including information related to licensure or clinical practice disciplinary actions, clinical practice restrictions, and medical malpractice suits, judgments and settlements.
• Maintains current knowledge of and compliance with medical staff accreditation standards with applicable regulatory agencies and licensing standards.
• Participates in the development and implementation of credentialing policies and procedures.
• Populate vRad systems (Echo) with new rad information off of original CV for onboarding physicians to initiate automated processes
• Communicate with radiologists to fulfill requests for health form status compliance
• Assist the Credentialing Specialist with obtaining primary source verifications (PSV)
• Prepare and present radiologist’s reappointment files to the Credentialing Committee and Board in compliance with physician services reappointment processes
• Execute reports as necessary out of the system
• Perform in a coordinator role to complete projects related to all aspects of credentialing and verification.
• Assist in the completion and maintenance of all medical malpractice applications for program implementation and data maintenance of surgeon files.
• Assist with payer and facility verification processes
• Assist with billing activities
• Perform general administrative and clerical duties

Skills: File Maintenance, Regulatory Compliance, Credentialing Policy Development, System Data Management, Communication with Radiologists, Primary Source Verification, Report Preparation and Presentation, Administrative and Clerical Support

• Manage approximately 30 insurance carrier relationships to process hundreds of Benefit Advisor appointments and certifications
• Create and maintain process and procedure documentation for each carrier and requirements
• Maintain weekly/quarterly/annual agent roster audits with carriers
• Build strong relationships with carriers for ensure efficient BA onboarding
• Respond to internal and external agent contracting queries
• Maintain appointment and certification data integrity within the Individual Marketplace data management system
• Actively maintain awareness of widespread issues related to appointments and certifications, and escalate such issues to carrier partners
• Enter, edit, and maintain certification exams within the Confluence system for carriers whose certifications we host
• Handle escalated certification technical and access-related issues and escalate them through the appropriate avenues
• Handle incoming certification help desk requests during off-peak season
• Actively contribute to team and cross-functional teams to exceed corporate goals

Skills: Insurance Carrier Relationship Management, Process and Procedure Documentation, Agent Roster Audits, Carrier Onboarding, Contracting Query Response, Data Integrity Management, Issue Awareness and Escalation, Certification System Management

• Initiates letters of inquiry regarding education, training, personal medical references, staff affiliations, board certifications, out-of-state licensure and relevant information. 
• Requests verification from the Medical Board of California for current state licensure.
• Creates confidential files on new practitioners and obtains copies of state licensure/s and certificates
• Conducts thorough background investigation, research and primary source verification of all components of the application file. 
• Performs primary source verification of all necessary elements through letters or faxes, websites, telephone verifications or equivalent sources.
• Follows up on all incomplete or problematic information in a timely and consistent manner. 
• Ensures that all reappointments are completed and reviewed by the appropriate credentialing entity before the expiration date. 
• Tracks license and certification expirations for all providers to ensure timely renewals.
• Assists with conducting an annual review of Medical Staff Bylaws, rules and regulations and all documents pertinent to the medical staff who are maintained in the department. 
• Submits sections for revisions to appropriate committees. 

Skills: Credentialing and Verification, Background Investigation, Documentation Management, Regulatory Compliance, Problem Resolution, Process Improvement, Communication Skills, Organizational Skills

• Responsible for coordinating, monitoring, and maintaining the credentialing process and reappointment paperwork to keep us up to date with health plans and government agencies.
• Ensures interpretation and compliance with all regulatory and accrediting organizations for the laboratory and physicians, while developing and maintaining a working knowledge of the statuses and policies relating to credentialing.
• Responsible for the accuracy and integrity of the credentialing database system.
• Assures compliance with all health plan requirements as related to the provider certification and credentialing.
• Manages and monitors activities to ensure compliance with all procedures and regulations.
• Gather appropriate paperwork and submit to payer for processing.
• Follow up on applications to obtain approval to bill for services rendered.
• Work closely with payers to process these forms accurately and efficiently.
• Reviews and streamlines processes and workflows, using automation, where appropriate.
• Participate in the development and implementation of credentialing processes and procedures and provide input in regard to process improvement.

Skills: Credentialing Management, Regulatory Compliance, Database Accuracy, Health Plan Requirements, Process and Workflow Optimization, Documentation and Submission, Payer Relations, Process Improvement

• Knowledge of the health care and credentialing industry, including medical-legal issues and laws, regulatory agencies, and other national standards
• Strong knowledge of Medicare and NCQA standards.
• Ability to possess Certified Provider Credentialing Specialist
• Strong communication skills (written and verbal)
• Strong computer skills (analytics, database and spreadsheet reporting)
• Excellent communication and customer service skills
• Experience in attendance at meetings and transcription of minutes
• Experience in credentialing physician applications
• Experience with the Cactus database 
• Ability to possess CPCS certification.

Qualifications: BA in Healthcare Administration with 2 years of Experience

• Experience with Query NAMSS, NPI Registry, AMA, & NPDB databases for all new physician hires
• Experience in adding new hires to Master Database and MD-Staff
• Ability to communicate with physicians regarding onboarding, credentialing, or reappointment documentation needed
• Ability to place equipment requests for onboarding physicians at the appropriate time during the onboarding process
• Ability to communicate any flags or concerns to the Credentialing Manager
• Ability to collect all required credentialing documents listed on the checklist (medical degrees & training certificates, board certification, DEA, ECFMG, identification, license copies, CMEs, etc.)
• Ability to assist with maintenance of MD-Staff credentialing tasks and database
• Ability to assist with incoming work verification requests from other facilities for past/present radiologists
• Ability to assist Credentialing Manager with Facility Credentialing Projects
• Ability to assist Credentialing Manager with Licensing projects

Qualifications: BS in Business Administration with 4 years of Experience

• Ability to assist Credentialing Assistant with Expiring Licenses/COIs
• Ability to assist with Joint Commission Audit, if needed (tri-annual)
• Ability to participate in weekly credentialing call
• Ability to provide Salesforce updates regarding credentialing/onboarding
• Ability to attend training sessions and educational webinars, with or at the recommendation of the Credentialing Manager, to further knowledge of the department and its responsibilities
• Ability to archive credentialing files
• Assist the Credentialing Manager and Credentialing Coordinator with any additional assignments
• Proficiency in MS Office applications
• Experience with medical credentialing software
• Intermediate computer skills in Microsoft Excel, Outlook, and Word
• Experience in insurance, medical, or healthcare Credentialing
• Ability to possess Certified Provider Credentialing Specialist (CPCS) or other credentialing certification

Qualifications: BA in Public Health with 3 years of Experience

• Experience in updating Provider demographic data in the CACTUS credentialing system.
• Experience in working with department leadership to proactively identify providers who will be joining the FGP and establish appropriate service and billing information required for credentialing and payer enrollment.
• Ability to coordinate the submission of credentialing documents and demographic information to external vendors to initiate the credentialing and enrollment of providers into governmental and commercial health plans.
• Ability to communicate any possible barriers and delays in the credentialing process to all necessary parties in a timely fashion.
• Ability to track and monitor the end-to-end enrollment process of providers from the preparation of contracts to the end point of successful confirmation of linkage to payers.
• Ability to prepare and distribute weekly updates of any new provider enrollments and demographic updates.
• Ability to correspond with health plans to ensure the appropriate contract linkage on behalf of FGP providers.
• Ability to support the credentialing and contract management business needs of the Faculty Group Practice.
• Experience in completing and submitting credentialing applications to managed care insurance companies and governmental plans (CMS Medicare PECOS, NYS Medicaid, Workers Comp).
• Experience in completion of CAQH applications on behalf of NYU Langones employed provider network

Qualifications: BS in Health Information Management with 5 years of Experience

• Knowledge of/proficiency with Microsoft Office
• Knowledge of credentialing requirements
• Detail-oriented and organized with the ability to work independently and in a group setting.
• Strong research skills to gather pertinent information.
• Ability to communicate effectively, both orally and in writing.
• Ability to establish and maintain effective and cooperative working relationships with staff and others contacted in the course of work.
• Ability to think and work effectively under pressure and accurately complete tasks within established times.
• Ability to prioritize tasks and meet deadlines.
• Ability to embrace diversity within the work environment and consistently deal with internal and external customers in a friendly and respectful manner
• Ability to support teamwork and cooperation with work partners in daily activities.

Qualifications: BA in Medical Office Administration with 3 years of Experience