Credentialing And Payor Enrollment Specialist

City/State:

Bronx, New York

Grant Funded:

No

Department:

Dentistry - Billing Office

Work Shift:

Day

Work Days:

MON-FRI

Scheduled Hours:

8:30 AM-5 PM

Scheduled Daily Hours:

7.5 HOURS

Pay Range:

$56,000.00-$70,000.00

Department Duties

• Responsible for timely and accurate submission all initial hospital credentialing and payor plan enrollment for incoming providers

• Responsible for timely and accurate submission all hospital recredentialing and insurance plan reenrollment for existing providers

• Establish and maintain a database of all dental providers with complete credentialing and IPA information

• Serve as liaison between the providers and CMO and insurance offices. Proactively address any issues including missing documentation with providers

• Work closely with CMO and Dental Staff personnel to provide first line quality assurance in the processing of dental staff credential and re-credential applications in accordance with their regulations and requirements

• Attend and participate in CMO provider relations meetings

• Keep management informed early in the process of any delinquent or uncooperative providers

• Maintain confidential providers files in accordance with The Joint Commission requirements. Ensure documents with expiration dates are up-to-date, and follow-up with providers around renewals(i.e. license registration, DEA, board certifications etc)

• Maintain and update CAQH/ ADA Attestations for all eligible providers

• Manage and maintain taxonomy codes for all providers

• Process resignations and change of status with the CMO for all providers

• Attain qualification as a Notary Public

Qualifications

• High School diploma/ GED Required

• 1-3 years Hospital credentialing Required

• 1-3 years Insurance plan (Commercial, Medicaid, Medicare, and Medicaid/ Medicare Managed Care) enrollment Required

• 1-3 years dental credentialing and insurance plan enrollment Preferred

• Ability to work effectively with co-workers as a team member

• Ability to multitask in a fast paced environment

• Ability to work independently with minimal supervision

• Strong Interpersonal, oral, and written communication skills with excellent self-discipline and patience between payors, providers, physicians, and colleagues

• Identifies, analyzes, and resolves extraordinary information, discrepancies, time gaps, and other idiosyncrasies that could adversely impact ability to credential and enroll practitioners discovers and conveys problems to Credentialing Manager

• Proficient computer software and database skills

Montefiore Medical Center is an equal employment opportunity employer. Montefiore Medical Center 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.