North American Partners in Anesthesia

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Senior Credentialing Specialist

Senior Credentialing Specialist

# of Openings 
1
Job Locations 
US-NY-Melville
Category 
Contracting and Credentialing

More information about this job

Overview

As a team lead, the Senior Credentialing Specialist will be responsible for all functions of the credentialing process within assigned territories and/or specialty group(s).  In addition, the Senior Credentialing Specialist will have oversight, training, and problem solving responsibilities of the credentialing specialists.  Apply key skills and knowledge to ensure that providers meet payor or accreditation requirements within specified time frames.  Support the credentialing staff, management and Vice President of Contracting and Physician Services.

 

 


 

The Location

Melville, NY 

Position Requirements

Essential duties and responsibilities:

 

  • Complete and accurately submit provider payor enrollment applications, spreadsheets, and letters
  • Research & keep current on payer, hospital & office based guidelines as needed to ensure processes are accurate. Review workflows to identify accuracy, efficiency and best practices.
  • Follow up with payors to ensure timely enrollment and participation
  • Review and follow up on weekly billing reports
  • Data entry of all provider information into the Credentialing Database
  • Handling incoming requests from physicians, payors, and other agencies
  • Verify integrity of data
  • Complete online provider CAQH re-attestations
  • Assist with the development and maintenance of departmental policies and procedures
  • Assist/lead new business implementations
  • Oversee credentialing staff, monitor workflows, and provide support and training as required
  • Assist in internal departments by resolving payment and denial issues as it relates to credentialing
  • Travel between hospitals and other clinical work locations to meet with providers to obtain signatures on required documents
  • Possible travel between NAPA corporate sites (Melville and Virginia)
  • Facilitate and attend meetings and seminars as required
  • Produce weekly and monthly productivity and issues report for management
  • Other responsibilities as assigned

 

Qualification/Requirement:

 

  • Positive and professional attitude
  • Ability to work with all levels of associates from entry level to upper level management
  • Ability to work independently or in a group setting
  • Strong knowledge of provider credentialing in a physician office, managed care or hospital setting
  • Must be a self-starter and a team player who enjoys providing the highest level of customer service.
  • Experience working with databases, and ability to create and manipulate excel spreadsheets
  • Ability to multi-task and prioritize in a fast paced environment
  • Strong communication and follow up skills
  • Professional business sense and leadership skills
  • Strong experience with Microsoft Office (Excel & Word specifically)
  • Local & distance travel required.

 

Education and/or Experience

 

Associates Degree, Bachelor’s Degree, and/or equivalent work experience.  A minimum of three years credentialing experience.

 

 

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