Position Summary: We have an exciting opportunity to join our team as a Credentials Associate.
In this role, the successful candidate will be responsible for performing all processes and procedures (paper and electronic) related to Cactus database management for primary source verifications and contract enrollment for the UPN. The primary focus will be primary source verifications for both initial and re-credentialing applications as well as timely updating of credentialing database to accurately document plan enrollment and demographic updates. This individual is responsible for making daily compliance determinations regarding physician credentialing files and other monitoring activities including but limited to OIG sanctions and Medicare exclusions.
Manages data captured on the CAQH application, contract enrollment forms and demographic update requests.
Performs necessary primary source verifications in accordance with applicable regulatory and accreditation standards.
Consistently applies UPN, accreditation and regulatory standards to appropriately identify and prepare physician files which require review by the Credentials Committee Chairman.
Updates physician database (Cactus) and other tracking grids with physician demographics, managed care contract information, and other credentialing related information as needed.
Forwards health plan contracts for new provider enrollments and demographic updates to plans, maintain contact with physicians, office staff and health plans as necessary.
Other tasks and projects as assigned which support changing regulatory and business needs.
Minimum Qualifications: To qualify you must have a Bachelor's degree preferred, some college required 1-2 years of physician relations (e.g. contracting, credentialing, etc) in a HMO, IPA or large group practice setting. 1-2 years of experience using the CAQH application. 1-2 years of conducting primary source verifications. Knowledge of NCQA/JC standards Excellent written communication and oral presentation skills Exceptional organizational skills Superior customer service skills Proficient in the use of MS Excel and Word
Preferred Qualifications: Preferred Qualifications:Medical staff office experience preferred with credentialing certification from NAMSS (National Association of Medical Staff Services). Excellent verbal and written communication skills, including knowledge of medical terminology. Computer skills, including word processing and data base maintenance. Self-motivated with the ability to complete projects independently within established timeframes. Ability to handle multiple projects and deadlines. Ability to cope with interruptions, varying personalities, rush projects, and demanding medical staff. Must be well organized and able to prioritize responsibilities. Must have independent judgment and interpersonal relationship skills in working with medical staff leaders and other Departments in the NYU Health System. Affiliation with the National and State Association Medical Staff Services encouraged. Knowledge of Visual Cactus
Qualified candidates must be able to effectively communicate with all levels of the organization.
NYU Langone Health provides its staff with far more than just a place to work. Rather, we are an institution you can be proud of, an institution where you'll feel good about devoting your time and your talents.
NYU Langone Health is an equal opportunity and affirmative action employer committed to diversity and inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration without regard to race, color, gender, gender identity or expression, sex, sexual orientation, transgender status, gender dysphoria, national origin, age, religion, disability, military and veteran status, marital or parental status, citizenship status, genetic information or any other factor which cannot lawfully be used as a basis for an employment decision. We require applications to be completed online. If you wish to view NYU Langone Health's EEO policies, please click here. Please click here to view the Federal 'EEO is the law' poster or visit https://www.dol.gov/ofccp/regs/compliance/posters/ofccpost.htm for more information. To view the Pay Transparency Notice, please click here.
NYU Langone Medical Center, a world-class patient-centered integrated academic medical center, is one of the nation's premier centers for excellence in clinical care, biomedical research, and medical education. Located in the heart of Manhattan, NYU Langone is composed of four hospitals – Tisch Hospital, its flagship acute care facility; Rusk Rehabilitation; the Hospital for Joint Diseases, one of... only five hospitals in the nation dedicated to orthopaedics and rheumatology; and Hassenfeld Children's Hospital, a comprehensive pediatric hospital supporting a full array of children's health services across the medical center – plus the NYU School of Medicine, which since 1841 has trained thousands of physicians and scientists who have helped to shape the course of medical history. The medical center's tri-fold mission to serve, teach, and discover is achieved 365 days a year through the seamless integration of a culture devoted to excellence in patient care, education and research. For more information, go to www.NYULMC.org.