Medical Staff Credentialing Specialist, Sr. jobs in Rhode Island

Job Summary:

Under the direction of the Credentialing Supervisor, the Payer Credentialing Associate performs various credentialing research as well as clerical and office functions. Duties include but are not limited to data entry, and telephone calls to insurance payers, providers, and/or others for the purpose of accurate and timely information and processing. Other duties as necessary to assist the Credentialing Department to help with the facilitation of the payer credentialing process. The Payer Credentialing Associate functions as a liaison to coworkers, and internal and external customers to ensure appropriate and adequate support for the many functions performed within the Credentialing Department.

Duties and Responsibilities:

Working in conjunction with the credentialing team responsible for providing clerical assistance to the team as needed for daily, weekly duties, and other projects as assigned by the Credentialing Supervisor

Assist with the maintenance and updating of the CAQH database and internal database MSOW, as necessary for processing applications and to assure Data Directory is maintained per CMS guidelines.

Responds to emails, telephone calls, and correspondence daily in accordance with department policy and procedures.

Develop and maintain relationships with key contacts such as payers and internal departments.

Documents and resolves issues promptly, consistent with established department standards.

Cooperatively and effectively performs special payer research and/or projects as requested.

Preserves and protects providers’ information and privacy.

Performs other related duties as requested.

Requirements:

High school graduate or equivalent required.

1-3 years of prior experience in a healthcare or business setting preferred.

Computer experience with Microsoft Office products including Word, Outlook, and Excel is required.

Care New England Health System (CNE) and its member institutions, Butler Hospital, Women & Infants Hospital, Kent Hospital, VNA of Care New England, Integra, The Providence Center, and Care New England Medical Group, and our Wellness Center, are trusted organizations fueling the latest advances in medical research, attracting the nation’s top specialty-trained doctors, and honing renowned services and innovative programs to engage in the important discussions people need to have about their health.

Americans with Disability Act Statement: External and internal applicants, as well as position incumbents who become disabled must be able to perform the essential job-specific functions either unaided or with the assistance of a reasonable accommodation, to be determined by the organization on a case-by-case basis.

EEOC Statement: Care New England is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status

Ethics Statement: Employee conducts himself/herself consistent with the ethical standards of the organization including, but not limited to hospital policy, mission, vision, and values.