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Medical Staff Services Req # 2622232
Credentials Coordinator-Managed Care
The Credentials Coordinator-Manage Care is responsible for coordinating the Mount Sinai School of Medicine Faculty Practice Associates credentialing, re-credentialing and enrollment process in accordance with the Health Care Plans Delegated Credentialing Agreements and the FPA policies & procedures, industry best-practices, and regulatory requirements.
Roles & Responsibilities:
- Coordinates and administers all aspects of the health care delegated plan enrollment processes for the Faculty Practice Associates
- Collection of data from departmental Faculty Practice Associate physicians
- Gathering and reviewing enrollment requests, applications and contracts for completeness and accuracy
- Interaction with department and health plan representatives regarding provider enrollment submissions, provider demographics, patient access issues, and claims resolution research
- Creating systems records and inputting key data elements to facilitate downstream processing
- Performing independent verifications as required, including; education, training, experience, certifications and boards
- Participate in database QA activities including but not limited to report and database review and correction
- Ensure that all FPA members are properly and accurately enrolled in Health Care Plans
- Track all appointments, reappointments, change-in-status, demographic updates, and terminations from plans.
- Recording and maintaining key data elements in electronic and hard-copy file systems.
- Prepares status reports of work performed and next steps.
- Facilitates communication between department personnel and Health Care Plans, and Delegated Credentialing Operations.
- Participates in team-based problem solving activities
and process improvements.
- Associate’s degree; Bachelor’s degree preferred
- 2 years experience in Health Care Plan Credentialing/Provider Relations and/or auditing setting, or Hospital Health Care Enrollment
- Proficient with CACTUS Software, or similar credentialing system
- NAMSS certification, preferred
- Intermediate Microsoft programs skills (MS Word, Excel, Power Point)
- Knowledge of NCQA standards (and Joint Commission standards a plus)
- Knowledge of commonly-used concepts, practices, and procedures used in health care and physician credentialing
The Mount Sinai Health System believes that diversity is a driver for excellence. We share a common devotion to delivering exceptional patient care. Yet we’re as diverse as the city we call home- culturally, ethically, in outlook and lifestyle. When you join us, you become a part of Mount Sinai’s unrivaled record of achievement, education and advancement as we revolutionize medicine together.
We work hard to acquire and retain the best people, and to create a welcoming, nurturing work environment where you can develop professionally. We share the belief that all employees, regardless of job title or expertise, can make an impact on quality patient care.
Explore more about this opportunity and how you can help us write a new chapter in our story!
Over 38,000 employees strong, the mission of the Mount Sinai Health System is to provide compassionate patient care with seamless coordination and to advance medicine through unrivaled education, research, and outreach in the many diverse communities we serve.
Formed in September 2013, The Mount Sinai Health System combines the excellence of the Icahn School of Medicine at Mount Sinai with seven premier hospital campuses, including Mount Sinai Beth Israel, Mount Sinai Beth Israel Brooklyn, The Mount Sinai Hospital, Mount Sinai Queens, Mount Sinai West (formerly Mount Sinai Roosevelt), Mount Sinai St. Luke’s, and New York Eye and Ear Infirmary of Mount Sinai.
The Mount Sinai Health System is an equal opportunity employer. We promote recognition and respect for individual and cultural differences, and we work to make our employees feel valued and appreciated, whatever their race, gender, background, or sexual orientation.