Job description

Job description

Under the general supervision of the Director of Credentials, with independent decision making, will assist in the management of and serve as a liaison between the Managed Care/Provider Enrollment Department of Wyckoff Heights Medical Center and its various Insurance Carriers to enroll Providers into various participating plans of the Medical Center. Will perform all duties in a manner consistent with Wyckoff Heights Medical Center’s commitment to providing superior patient care and promoting good guest relations.

* Coordinates with the Credentials Department for credentialing reports to the delegated health plans as mandated in the delegation agreements.

* Coordinates with the Credentials Department for the delegated health plans annual audits.

* Verifies providers have been uploaded into the Plans’ systems and obtains ID numbers.

* Preparation, submission, and follow-up of provider applications for non-delegated health plans.

* Reporting of all additions, terminations, and changes to the delegated health plans as needed but no less than monthly, and maintaining proof of these submissions.

* Update and maintain provider’s CAQH profile

* Preparation, delivery, and (after completion) collection of provider enrollment packet to new provider.

* Performs all other duties as required by the department with relations to Managed Care and Provider Enrollment.

* Answers calls, mailings.

* Ad hoc reporting as needed.

* Processes files of terminated providers for archiving.

* Assists in building and maintaining the Apogee Database.

* Coordinates with the Director of Credentials to create and update Provider Enrollment policies and procedures.

* Performs maintenance and updates of provider credentials for continued participation in Health Plans.

Position Requirements:

* This position requires a minimum formal education of High School Diploma or equivalent and a minimum of 3 years job-related experience.

* Desired (not required) criteria include: Effective verbal, written, and organizational skills. Knowledge of CMS, NCQA, State and Federal regulations related to health plan credentialing activities. Computer knowledge, including working knowledge of Microsoft Office & MSOW Credentialing Software, CPCS OR CPMSM certification preferred.

* Self-starter and self-motivated, functions independently with minimal direction. Maintains professional demeanor and confidentiality. Flexible, team player. Must be able to work with a variety of people and circumstances.

Job Type: Full-time

Salary: $30.00 - $32.00 per hour

Benefits:

• Dental insurance
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Retirement plan
• Tuition reimbursement
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Work setting:

• In-person
• Office

Ability to commute/relocate:

• Brooklyn, NY 11237: Reliably commute or planning to relocate before starting work (Required)

Experience:

• Customer service: 1 year (Preferred)

Work Location: In person

Job Type: Full-time

Pay: $30.00 - $32.00 per hour

Benefits:

• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Schedule:

• 8 hour shift

Work setting:

• In-person

Experience:

• Customer service: 1 year (Preferred)

Work Location: In person

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