PHP Credentialing Specialist

Job Description:

JOB DUTIES -

• Performs all aspects of the Credentialing and re-credentialing process and solicit pertinent information for committee review. Maintain individual physician/provider permanent file and record of decisions regarding participation.
• Compose and distribute monthly Cactus Payor Update to all network/payors contacts.
• Responsible for preparation and execution of annual delegated credentialing network/payor audits.
• Maintain provider relations and serve as the point of contact for all communication between a Payor and the individual physician offices that are members of the PHO.
• Staff Committee meetings to include scheduling meetings, recording minutes and maintain permanent record of related proceedings.
• Provide professional education and information for office managers and staff regarding local managed care issues and other changes in the market through the practice manager/staff meetings and Zoom meetings/webinars.
• Promotes good public relations for Purchase Health Partners (PHP).
• Serves as needed on committees.
• Assists the PHP Coordinator and AVP Networks and Collaboration with other duties as assigned.
• Follows Hospital and Departmental Policies and Procedures.

QUALIFICATIONS AND ACCOUNTABILITY -A Bachelor's degree is required with a minimum of 5 years' experience in healthcare management pertaining to credentialing program, managed care, physician relations or a related field and proven communications and quantitative skills. Must have ability to prioritize multiple tasks and carry them through to completion in a timely, cost-effective manner. Supervised by the PHP Coordinator. The PHP Coordinator conducts performance evaluations at the end of the three-month probationary period. Evaluations, thereafter, are on a yearly basis.