Credentialing Coordinator at Melville

Job Description

CareCentrix is the nation’s leading provider of home health benefits management services. We provide health payers with a single source solution to manage all DME, home health and home infusion products and services.

Our home health benefits program coordinates and integrates all aspects of network management, utilization management and claims payment on behalf of our clients.Our comprehensive national network of credentialed providers enables CareCentrix to provide patients with timely access to appropriate, high quality, and cost effective durable medical equipment, home health and home infusion services.

The CareCentrix program suite includes our Care Transitions Program which allow our clients to reduce preventable hospital readmissions and ER visits within their membership; reducing costs associated with readmissions while increasing patient satisfaction.

CareCentrix is headquartered in East Harford, Connecticut with four Regional Care Centers located in Tampa, Florida; Phoenix, Arizona; Overland Park, Kansas and Albuquerque, New Mexico, and an administrative office in Melville, New York.

Ensures the existence of a corporate credentialing file for every fully contracted CareCentrix participant. Establishes positive working relationships with the providers for receipt and completeness of credentialing data. Works under general supervision.

Abides by and demonstrates the company Mission – Vision – Values through both behavior and job performance on a day-to-day basis.

Assists in preparing the initial credentialing file for all new provider applications and the re-credentialing file for existing providers.

Contacts provider and primary verification sources to obtain all necessary credentialing elements to ensure completeness.

Responsible for manual authorization and patient specific processing.

Inputs specified provider credentialing data into system database and tracks expiration dates for current file and system maintenance.

Maintains log of closed and terminated facilities and appropriately stores suspended files.

Responsible for storing files and maintaining overall neatness and organization of provider files and contracts.

Assists Supervisor and team in preparing monthly provider reports for Credentialing Committee meeting and distributes materials accordingly.

Handles routine filing of received documents and departmental information.

Must be available on occasion to work additional hours to complete certain high priority projects.

Adheres to and participates in Company’s mandatory HIPAA privacy program / practices and Business Ethics and Compliance programs / practices. Follows Utilization Management and URAC standards.

Reviews and adheres to all Company policies and procedures and the Employee Handbook.

Participates in special projects and performs other duties as assigned.

Job Requirements

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Experience Required

Associate’s Degree in Health, Business or the equivalent is generally preferred. Professional and consistent work experience is required. Effective oral/written organizational skills are essential. Knowledge of Utilization Management and URAC standards.

Expect more from CareCentrix

At CareCentrix you’ll find everything you need to make the most of your career, including skilled, collaborative associates; a team-oriented approach and the resources of a national company. When you work for CareCentrix, you can expect more: more opportunities, more challenges, more rewards.

*CareCentrix is an Affirmative Action/Equal Opportunity Employer M/F/D/V encouraged to apply.
Country: USA, State: New York, City: Melville, Company: CareCentrix.