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 administrative experience in a general office environment required and two (2) years credentialing experience in a managed care or medical environment preferred
  • 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 - 21 months ago - save job - block
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