Provider Credentialing Specialist

ElderServe Health is a mission-driven, nonprofit managed care organization serving the New York metropolitan area. ElderServe provides long-term services and supports to more than 20,000 older adults and adults with disabilities across New York City, as well as Westchester, Nassau, and Suffolk Counties. ElderServe primarily serves a frail and elderly membership who is predominantly dual-eligible and enrolled in Medicaid managed long-term care, Medicare-only and integrated Medicaid-Medicare plans. The CareSource and ElderServe affiliation addresses these critical long-term care needs to help members be as healthy and independent as possible.

Job Summary:

The provider Credentialing Specialist is responsible for facilitating the centralized credentialing process for the company's providers, addressing all functions for initial and re-credentialing of Specialty Partners providers in accordance with departmental policies and procedures.

Essential Functions:

• Collect and document provider credentials per credentialing and re-credentialing protocols, guidelines and policy/procedures.
• Notify providers of new and additional credentialing requirements.
• Maintain and update databases, including the provider database and directory.
• Process rosters and updates from delegated providers.
• Generate data reports as needed.
• Assist with Provider Relations activities, including preparing required provider network data for submissions, reviewing submission results and preparing responses to network deficiencies.
• Respond to staff and provider network inquiries.
• Participate in department projects and provide support to the Department as needed, including review provider documents, including provider application, attestations, and credentials for processing provider contracts, letters of agreement, contract amendments, and notices.
• Perform any other job related duties as requested.

Education and Experience:

• High School or GED diploma required
• Two (2) years experience with Medicare and Medicaid Provider Network Requirements required

Competencies, Knowledge and Skills:

• Strong Data Analysis Experience
• Proficient in Microsoft Word and Excel
• Ability to absorb details accurately
• Excellent organizational skills
• Strong Interpersonal and Communication Skills
• Attention to detail
• Familiarity of the healthcare field
• Knowledge of medical terminology
• Knowledge of Medicaid & Medicare managed care
• Critical listening and thinking skills
• Uses proper grammar
• Technical writing skills
• Time management skills
• Proper phone etiquette
• Customer service orientated
• Decision making/problem solving skills

Licensure and Certification:

• None

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• Travel is not typically required

Compensation Range:
$47,400.00 - $76,000.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type:
Hourly

Competencies:
- Fostering a Collaborative Workplace Culture
- Cultivate Partnerships
- Develop Self and Others
- Drive Execution
- Influence Others
- Pursue Personal Excellence
- Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.