What are the responsibilities and job description for the Credentialing Coordinator position at Integrated Resources?
Shift - 9 AM - 5 PM Hybrid
Pay - $25 - $30
Overview
Committed to empowering New Yorkers by uniting communities through care.
Believes healthcare is a right, not a privilege.
Seeking a Credentialing Coordinator to join the Credentialing Department .
Responsible for credentialing new providers (including Behavioral Health providers & facilities ), re-credentialing, and processing provider demographic updates and changes.
Ensures confidentiality and secure maintenance of credentialing documentation.
Assists facilities and providers in understanding and adhering to the client's credentialing policies and procedures.
Product of Role & Responsibilities
Maintain communication with credentialing contacts at facilities and provider sites for credentialing, re-credentialing, and provider information updates.
Review re-credentialing and credentialing files for completeness before presenting to the Credentialing Committee .
Perform primary source verification as per regulatory guidelines and client policies.
Enter and update provider information in credentialing and other relevant databases.
Verify New York State OProduct, Medicare / Medicaid lists, licensure restrictions, and practice limitations for credentialed providers during interim credentialing periods.
Check New York State license registration and DEA registration for all credentialed providers in interim periods.
Generate and distribute monthly provider credentialing updates to relevant departments and participating providers.
Respond to requests for credentialing information and provide copies of credentialing files to internal departments.
Create and disseminate provider rosters to delegated facilities and contracted groups.
Perform provider roster reconciliation .
Maintain credentialing documentation by creating, copying, filing, and organizing provider credentialing folders.
Ensure confidentiality by filing credentialing folders in secured cabinets.
Conduct annual delegated file audits and participate in pre-delegation and delegation site reviews .
Respond to provider credentialing status inquiries from client departments.
Perform additional tasks as directed by the Deputy Chief Operating Officer, Credentialing Director, or Credentialing Team Lead .
Required Education, Training & Professional Experience
High School Degree required ; Bachelor's Degree preferred .
2 years of experience in provider credentialing processes and procedures.
Knowledge of CACTUS preferred .
Ability to handle multiple projects simultaneously .
Strong understanding of managed care and physician credentialing .
Ability to meet deadlines and multitask in a dynamic healthcare environment.
Knowledge of initial credentialing, re-credentialing, and credential modifications .
Licensure & Certification
None required .
Professional Competencies
Integrity and Trust .
Customer Focus .
Proficiency in Microsoft Office (Word, Excel, Access).
Excellent communication (verbal & written) and organizational skills .
Schedule Start Date :
03 / 31 / 2025
Schedule Start Date :
03 / 31 / 2025
Schedule Hours Per Week :
40.00
Schedule Hours Per Day :
8.00
Schedule Notes :
Hybrid 9-5 Maintain communication with the credentialing contacts at facilities and provider sites to coordinate receipt of information required for credentialing, re-credentialing, and update of provider credentialing information
Review provider re-credentialing and credentialing file for completion and presentation to the Credentialing Committee.
Perform primary source verification on required elements and in accordance regulatory guidelines and MetroPlusHealth's policies and procedures
Data entry and upkeep of provider information in the credentialing and other pertinent databases
Verify New York State OProduct, Medicare / Medicaid lists and other pertinent databases for any current sanctions, restrictions on licensure and / or limitations on the Product of practice on all credentialed providers in interim credentialing periods
Verify New York State license registration and DEA registration status for all credentialed providers in the interim credentialing periods
Generate and disseminate monthly provider credentialing updates to appropriate departments at MetroPlusHealth and participating facilities and provider groups
Review and respond to request for credentialing information / copies of credentialing files to appropriate departments within MetroPlusHealth
Generate and disseminate provider rosters to delegated facilities, contracted group practices etc.
Perform provider roster reconciliation
Create, copy, file, and maintain all relevant documentation into provider credentialing folder.
Maintain confidentiality of provider credentials by filing the credentialing folder in respective cabinets in the file rooms
Keep a pulse on the job market with advanced job matching technology.
If your compensation planning software is too rigid to deploy winning incentive strategies, it’s time to find an adaptable solution.
Compensation Planning
Enhance your organization's compensation strategy with salary data sets that HR and team managers can use to pay your staff right.
Surveys & Data Sets
What is the career path for a Credentialing Coordinator?
Sign up to receive alerts about other jobs on the Credentialing Coordinator career path by checking the boxes next to the positions that interest you.
