Mount Sinai Careers

Specialist, Provider Data Managment and Credentialing- Mount Sinai Health Partners

New York, New York
Professional / Managerial / Administrative


Job Description

 

Mount Sinai is one of the largest non-profit health systems in the U.S. with a strong reputation for quality of care (18th ranked academic medical center) and research/education (22nd ranked medical school). Our health system has ~40,000 employees working together to provide billions of dollars in high-quality care for millions of patients each year.

 

We are accelerating a transition to a business model focused on population health management – our goal is to keep entire communities healthy and out of the hospital.  Mount Sinai Health Partners (MSHP) is the team driving this transformation within Mount Sinai.  The team includes 400+ employees with clinical, contracting, finance, IT, analytics, operations, and product development expertise. 

 

MSHP is a fast growing business unit within Mount Sinai and is looking for team members who:

 

·         Are comfortable “playing up” and “playing down” as needed to accomplish business objectives

·         Work productively amidst ambiguity

·         Thrive in fast-paced  work environments

·         Seek to improve the status quo 

 

Within MSHP, the Provider Data Management and Credentialing Team is responsible to maintain the provider network demographic data and the credentialing data needed to support multiple functions with in MSHP. I.e., Provider Search Tool, Health Plan Submissions, Provider Engagement Support Team, etc. Our team is devoted to making sure our data is consistent and accurately.

 

Role Summary

MSHP seeks a Provider Data Management & Credentialing Specialist which will report to the manager of the department. The specialist will be responsible for ensuring the data integrity for contracted providers in MSHP. This includes ongoing auditing of the provider database, monitoring provider sanctions from regulatory agencies, participation status with payer programs, and other demographic and credentialing and contractual requirements. Responsible for timely and accurate reporting to management, payers and other business partners.

Responsibilities

Responsibility #1

·         Verify with multiple primary sources organizations (i.e., New York State DOE, NPDB, ABMS, OIG, etc.) provider‘s status during initial credentialing and recredentialing cycles.

·         Participate in ongoing sanctions monitoring process for contracted providers in the organization (i.e., FEHBP, OIG, OPMC, etc.).

·         Communicate with providers to obtain requisite information to facilitate timely processing and follow up on inquiries from providers, internal departments or payers related to the credentialing processes/data.

·         Coordinate credentialing related data/profiles with various sources (i.e., Internal departments, provider groups, etc.) to support credentialing delegated arrangements.

 

Responsibility #2

·         Conduct analysis on data integrity across the department’s multiple processes such as Credentialing and Provider Data Management activity.

·         Participate in department activity for any payer initiatives related to provider data veracity and exchange.

 

Responsibility #3

·         Participate in project implementation of major changes to the department’s processes.

·         Participate in ongoing department process improvement initiatives.

·         Perform related duties and special projects, as assigned.

 

Qualifications                   

Education and Experience

·         Bachelor’s Degree or equivalent of at least two (2) years on Credentialing work experience and two (2) years in Provider Data Management/Operations.

 

Additional Skills and Qualities

·         Ability to research and analyze data

·         Highly attentive to detail and strong organizational skills

·         Clear and Concise written and verbal communication skills