Under the direction and supervision of the Manager, Credentialing & Provider Relations, responsible for managing the timely and accurate credentialing and re-credentialing of new and existing providers with all Yale Medicine contracted carriers and their appropriate carve-out vendors, including CT Medicaid and Medicare enrollment and re-enrollment. Research claim reimbursement issues due to provider enrollment and help to facilitate resolution as needed.
Posting Position Title: Credentialing Coordinator
University Job Title: Credentialing Associate of Yale Medicine
Work Week: Standard (M-F equal number of hours per day)
Required Skill/ability 1: Comprehensive knowledge of medical credentialing for managed care companies, provider enrollment processes requirements and terminology for commercial insurance companies and government sponsored plans e.g. Medicare and Medicaid, as well as relevant terminology.
Required Skill/ability 2: Strong grasp of regulatory, health plan and physician organization NCQA accrediting/certifying standards. Working knowledge of Medicaid and Medicare payer systems.
Required Skill/ability 3: Excellent oral and written communication skills, ability to compose written/electronic communication independently. Ability to respond to inquiries from internal and external clients promptly and accurately.
Required Skill/ability 4: Ability to prioritize multiple work assignments in varying stages of completion with a high degree of accuracy and attention to detail to meet complex goals and deadlines, as well as ability to exercise independent judgment and maintain composure while working under deadlines.
Required Skill/ability 5: Strong computer skills (Word, Excel). Strong organizational and customer service skills. Ability to maintain a high level of confidentiality and use appropriate discretion with respect to information being reviewed and processed.
Preferred Education, Experience and Skills: Bachelor's degree. Advanced Access database skills including ability to create reports and queries. Three years of current medical credentialing experience. Certified Professional Credentialing Specialist (CPCS) certification from National Association of Medical Staff Services (NAMSS).
Required Licenses Or Certifications:
Eight years of related work experience, six of them in the same job family at the next lower level and a high school level education; or six years of related work experience and an Associate's Degree; or two years of related work experience and a Bachelor's Degree; or an equivalent combination of education and related experience.
Yale University is an American private Ivy League research university located in New Haven, Connecticut. Founded in 1701 in the Colony of Connecticut, the university is the third-oldest institution of higher education in the United States.