Provider Data Management & Credentialing Specialist - Mount Sinai Health Partners
Provider Data Management & Credentialing Specialist - Mount Sinai Health Partners
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USD 58661 - 74250
1 Vacancy
Job Description
The Provider Data Management and Credentialing Specialist is responsible for ensuring the data integrity for contracted providers. This includes ongoing audit of the provider database monitoring provider sanctions from regulatory agencies participation status with payer programs and other demographic and credentialing and contractual requirements. This individual is responsible for timely and accurate data reporting to management payers and other business partners.
Responsibilities
1. Conducts analysis on data integrity across the departments multiple processes such as Credentialing and Provider Data Management activity.
2. Participates in ongoing sanctions monitoring process for contracted providers in the organization (i.e. FEHBP OIG OPMC etc.).
3. Participates in department activity for any payer initiatives related to provider data veracity and exchange.
4. Participates in project implementation of major changes to the departments processes.
5. Participates in ongoing department process improvement initiatives.
6. Performs related duties and special projects as assigned.
7. Maintains patient/employee confidentiality in the management of information
8. Observes Mount Sinai Health System compliance policies
9. Implements and maintains established Health Care System policies and procedures.
10. Verifies with multiple primary sources organizations (i.e. New York State DOE NPDB ABMS OIG etc.) providers status during initial credentialing and recredentialing cycles.
11. Communicates with providers to obtain requisite information to facilitate timely processing and follows up on inquiries from providers internal departments or payers related to the credentialing processes/data.
12. Coordinates credentialing related data/profiles with various sources (i.e. internal departments provider groups etc.) to support credentialing delegated arrangements.
13. Other duties as assigned
Qualifications
- Bachelors Degree or combination of education and equivalent business experience.
- 2 years minimum in credentialing.
- 2 years minimum in provider operations.
Non-Bargaining Unit E01 - Partner MSO Services - MSH Mount Sinai Hospital
Required Experience:
Unclear Seniority
Employment Type
Full-Time
