Provider Relations Specialist
1199SEIU Family of Funds - New York, NY

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Responsibilities

Perform primary provider source verifications of license, Drug Enforcement Administration (DEA) number, hospital affiliation, board certification status, malpractice history and sanction activity through various web-based agencies and sources

Research and summarize provider’s malpractice history for Credentialing Committee review

Enter and review provider information in Trinity system; prepare reports as needed

Confirm authenticity of documents and ensure pre-established criteria has been met; return provider applications that do not meet criteria

Verify and review provider applications, participation agreements or designations of provider groups for completion

Follow up with providers or office managers in regards to missing or expired information in the credentialing application or documentation

Check provider status files for duplication and possible conflicting information

Perform statistical analysis via Excel spreadsheet

Perform additional duties and projects as assigned by management

Qualifications

High School Diploma or GED required, some College or Degree preferred; plus

Minimum two (2) years credentialing experience in a managed care or medical environment preferred

Minimum two (2) years administrative experience in a general office environment required

Basic skill level in Microsoft Word and Excel required

Excellent interpersonal and communications skills – both verbal and written

Strong analytical, problem-solving, time management and organizational skills

Must be detail-oriented, able to exercise good judgment and work well independently

Able to multi-task and follow through on assignments to completion

Ability to prioritize work with tight schedules and target dates

Must meet performance standards including attendance and punctuality

1199SEIU Family of Funds - 2 years ago - save job