CREDENTIALING SPECIALIST

The Credentialing Specialist will report to the Assistant Director of Client Services and will provide project management for providers with charges held in the billing system, pending credentialing, or for credentialing errors.

The incumbent will act as the primary  liaison between the Montefiore Care Management Organization (CMO), that is in charge of the credentialing process for the Faculty Practice providers, and departments.

Job Responsibilities

• Manage credentialing to ensure that applications are done in accordance with regulations; and in a timely manner
• In charge of monitoring the credentialing process and analyzing the billing data to identify time gaps and other issues that could adversely impact the ability to credential and enroll practitioners; ultimately avoiding revenue loss.
• Discovers and conveys problems to CMO for sound decision making in accordance with Medical Staff Bylaws, credentialing policies and procedures, federal, state, local and government/insurance agency regulations.
• Track outcomes, analyze results, and provide regular reports regarding the status of credentialing to Professional Services and Faculty Practice leadership
• The Credentialing Specialist will need to be a self-starter, organized,  and have a strong ability to manage multiple projects
• Work closely with departmental credentialing specialists, leadership, and key stake holders to identify key area’s of improvement
• Reconcile provider enrollment data with EPIC and/or payor rosters as needed
• Field ad-hoc requests as needed from Assistant Director, Client Services, or other departments impacted by credentialing (ie PSU, AR Operations, etc)
• Incumbent will be responsible for promoting best practices and handle credentialing related projects, which will require the specialist to develop flow charts, check list, tip sheets, etc.

Requirements

• Associates Degree Required; Bachelor Degree Preferred
• 3 Years work experience
• Knowledge of provider credentialing and its direct impact on the practice’s revenue cycle.
• Ability to use independent judgment and to manage and impart confidential information.
• General Business Office
• Software: Microsoft Office, EPIC, Intermediate Excel Skills Preferred

Department: Professional Services Bargaining Unit: Non Union Campus: YONKERS  Employment Status: Regular Full-Time Address: 3 Executive Boulevard, Yonkers
Shift: Day Scheduled Hours: 8:30 AM-5 PM Req ID: 212801 Salary Range/Pay Rate: $58,500.00  $70,000.00    

For positions that have only a rate listed, the displayed rate is the hiring rate but could be subject to change based on shift differential, experience, education or other relevant factors.

To learn more about the “Montefiore Difference” – who we are at Montefiore and all that we have to offer our associates, please click here.  

Diversity, equity and inclusion are core values of Montefiore. We are committed to recruiting and creating an environment in which associates feel empowered to thrive and be their authentic selves through our inclusive culture. We welcome your interest and invite you to join us.

Montefiore is an equal employment opportunity employer. Montefiore will recruit, hire, train, transfer, promote, layoff and discharge associates in all job classifications without regard to their race, color, religion, creed, national origin, alienage or citizenship status, age, gender, actual or presumed disability, history of disability, sexual orientation, gender identity, gender expression, genetic predisposition or carrier status, pregnancy, military status, marital status, or partnership status, or any other characteristic protected by law. 

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