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Westchester Medical Center Health Network · 2 months ago

Manager,Credentialing

Valhalla, NY

Full-time

Onsite

Mid, Senior Level

6+ years exp

Westchester Medical Center Health Network is seeking a Credentialing Manager responsible for overseeing all aspects of credentialing and re-credentialing of WMCAPS providers. The role involves ensuring healthcare professionals are appropriately credentialed and maintaining current information in the credentialing database.

Hospital & Health Care

Responsibilities

Completion of health care professionals credentialing and re-credentialing applications

Data entry of new applications in the credentialing database

Collect documentation for licensing, board certifications, proof of professional liability insurance, National Data Bank (NPDB) and/or other sources as required

Maintain the credentialing database and ensure up-to-date information is obtained at all times

Responsible for monitoring and managing credentialing/re-credentialing requirements to ensure the collection of all required renewal certifications are on file within the required time frame

Provide consistent and timely follow-up on all outstanding credentialing/re-credentialing files

Prepare and scan credentialing/re-credentialing files and other credentialing documentation

Answer credentialing telephone line and provide support to physicians, practice office staff, health plan contacts and company departments as necessary

Process provider/group demographic changes ensuring appropriate documentation has been submitted with the changes, update credentialing database and notify health plans of changes

Process provider network terminations, specialty/category changes, etc

Cross train within department to support credentialing operations (providing back-up support for telephones, credentialing files, and vacation/PTO)

Participate in various educational training as required

Perform other related duties as assigned by administration

Comply with HIPAA and Corporate Compliance program policies and other applicable corporate and departmental policies

Maintain privacy and confidentiality at all times

Qualification

Credentialing experienceManagement experienceCAQH databaseCredentialing regulations knowledgeCommunication skillsOrganizational skills

Required

Minimum of three (3) years of supervisory or management level experience in credentialing

Minimum of six (6) years credentialing experience

Experience with CAQH database and application process

Working knowledge of credentialing accreditation regulations, policies and procedures, and standards

Attend meetings and conferences related to job functions and responsibilities

High school diploma or equivalent required

Preferred

Bachelor's Degree preferred

Company

Westchester Medical Center Health Network

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The Westchester Medical Center Health Network (WMCHealth) is the pre-eminent provider of integrated health care in New York’s Hudson Valley region, serving nearly 2.5 million residents across more than 6,000 square miles.

Founded in 1917

Valhalla, New York, US

10001+ employees