Job #: 5467

Title: Credentialing Coordinator


  • New York City, NY
  • Job Type:

  • Contract
    • Anywhere
    • Posted 3 years ago

    The responsibilities of this position include but are not limited to perform most tasks related to the credentialing of new providers, including document collection and verification, and provider credentialing file maintenance. Also ensure that all credentialing supporting documentation is confidential and maintained in a secure environment. As well as assisting facilities and providers in understanding and adhering to MetroPlus’ policies and procedures regarding the credentialing process. Key Responsibilities: 1. Maintain communication with the credentialing contacts at facilities and provider sites to coordinate receipt of information required for credentialing, re-credentialing, and update of provider credentialing information 2. Review provider-credentialing file for completion and presentation to the Credentialing Committee 3. Perform primary source verification on required elements and in accordance with MetroPlus’ policies and procedures 4. Data entry and upkeep of provider information in the credentialing database 5. Verify New York State OPMC and Medicare/Medicaid for any current sanctions, restrictions on licensure and/or limitations on the scope of practice on all credentialed providers in interim credentialing periods 6. Generate and disseminate monthly provider credentialing updates to appropriate departments at Health Plan and participating facilities and providers 7. Create, copy, file, and maintain all relevant documentation into provider credentialing folder 8. Perform annual delegated file audits and participate in pre-delegation and delegation site reviews 9. Respond to inquiries from other MetroPlus departments relative to a provider’s credentialing status 10. Performs other related tasks as directed by the Director of Provider Services and the Credentialing Manager

    •Excellent communication and organizational skills •Previous experience with provider credentialing processes and procedures • Knowledge of  credentialing policies and procedures preferred •Good computer skills and able to work with MS Office •Knowledge of CACTUS preferred​

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