CREDENTIALING SPECIALIST
OCHIN
- New York, New York, United States
- New York, New York, United States
Über
Timely processing of initial credentialing and recredentialing applications in accordance with regulatory requirements (NCQA, HRSA/FTCA, Joint Commission, AAAHC, CMS, or other regulatory standards). Reviewing and analyzing credentialing applications and supporting documents for accuracy and completeness. Validating and verifying provider credentials (licensure, DEA, specialty board, certificates, professional liability, and other required documents) through the appropriate verification sources. Identifying discrepancies in information, conducting research and follow-up, and escalating unresolved issues. Completing payor provider enrollment process, performing revalidations, maintaining CAQH profiles, NPPES registrations, provider data with payers and managing plan enrollment status in credentialing system. Other duties as assigned. RequirementsMinimum of three (3) years of progressive experience in Credentialing and/or Provider Enrollment, 5+ years preferred. In-depth knowledge of credentialing, privileging and provider enrollment standards (HRSA, FTCA, TJC, NCQA, etc.) preferred. Experience in MD-Staff preferred. Certified Provider Credentialing Specialist (CPCS) may be required or strongly preferred. (Must be NAMSS not AAPC) Proficiency in credentialing software and data management systems is preferred. Advanced Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, etc.) preferred. Working knowledge of Smartsheet including data structure, formula creation, basic workflows and automation preferred. Proven experience in client-facing roles, with the ability to build strong relationships and communicate effectively with diverse stakeholders preferred. Familiarity with Jira for issue tracking and task management preferred.
Prior to moving forward to the team interview, all candidates are required to complete a 50-60-minute competency assessment. The assessment gives us insights into how your strengths, preferences, and work style align with th e OCHIN's nine core competencies. It's not about passing or failing-it's about understanding fit and setting you up for success.
Physical Requirements/Work Environment:
Constant interpersonal skills, teamwork, and customer service. Frequent creativity, mentoring, presentations, and teaching. Occasional decision making and independent judgment or action. Reading, speaking, writing, and understanding English. While performing the duties of the job, the employee is regularly required to sit for long periods of time; stand and walk; use hands to finger, handle or feel; reach with hands and arms. This position requires a virtual home-office environment, working remotely. The role routinely uses standard office equipment such as computers and mobile devices. Travel is required to support OCHIN's business requirements for Go-Live installations or training which may require travel by air, vehicle, or train. Work Location and Travel Requirements OCHIN is a 100% remote organization with no physical corporate office location. Employees work remotely from home and many of our positions also support our member organizations on-site for new software installations. Nationwide travel is determined based on OCHIN business needs. Please inquire during the interview process about travel requirements for this position. Work from home requirements are:
Ability to work independently and efficiently from a home office environment High Speed Internet Service It is a requirement that employees work in a distraction free workplace
We offer a comprehensive range of benefits. See our website for details: https://ochin.org/careerCOVID-19 Vaccination Requirement To keep our colleagues, members, and communities safe, OCHIN requires all employees-including remote employees, contractors, interns, and new hires-to be vaccinated with a COVID-19 vaccine, as supported by state and federal public health officials, as a condition of employment. All new hires are required to provide proof of full vaccination or receive approval for a medical or religious exemption before their hire date. Equal Opportunity Statement OCHIN is an equal opportunity employer. We are committed to building a team that represents a variety of backgrounds, perspectives, and skills for the benefit of our staff, our mission, and the communities we serve.
As an equal opportunity and affirmative action employer, OCHIN does not discriminate on the basis of race, color, ethnicity, national origin, sex (including pregnancy), gender identity, sexual orientation, genetic information (including family medical history), political affiliation, religion, marital or civil union status, parental status, age, disability status, military status, veteran status, or any other protected characteristics. All aspects of employment are based on merit, performance, and business needs.
Base Pay Overview OCHIN uses broadened pay ranges to support equitable and market-aligned compensation practices. The final offer will be based on a variety of factors, including relevant skills, certifications, education, experience, training, responsibilities, internal equity, and market data. #LI-Remote Salary Description $23.56 - $37.69
Sprachkenntnisse
- English
Hinweis für Nutzer
Dieses Stellenangebot stammt von einer Partnerplattform von TieTalent. Klick auf „Jetzt Bewerben”, um deine Bewerbung direkt auf deren Website einzureichen.