• Credentialing Coordinator

    Job Locations US-NY-Brooklyn
    Req #
    107262
    Agency
    Elderplan
    Status
    Regular Full-Time
    Location : Postal Code
    11220
    Category
    Provider & Network Contracting
    Office or Field
    Office-based
  • Overview

    The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.

    Why work for MJHS?

    When you work with us you will receive comprehensive and affordable health and financial benefits, in addition to generous paid vacation, personal and holiday time that you won't find at our competitors. Do you receive a paid day off for your birthday now? No?  You will here!  You will also receive the training, tuition assistance and career development you desire to help you achieve your career goals.  You take care of our patients, residents and health plan members, and we will take care of the rest!

     

    Benefits include:

    • Sign-on Bonuses OR Student Loan Assistance for clinical staff
    • FREE Online RN to BSN and MSN degree programs!
    • Tuition Reimbursement for all full and part-time staff
    • Dependent Tuition Reimbursement for clinical staff!
    • Generous paid time off
    • Affordable medical, dental and vision coverage for employee and family members
    • Two retirement plans! 403(b) AND Employer Paid Pension
    • Flexible spending
    • And MORE!

    Responsibilities

    Oversees the proper credentialing/recredentialing of all providers within the Home First network including but not limited to site visitation, application processing and information verification. Implements quality improvement. Responsible for the development and creation of provider contracts, provider manual and member network provider directory. Creates provider reports based on paid claims data. Oversees the daily management of sub-network agreement. Audits claims processing functions to determine error rate. Sends network providers correspondence regarding changes in the MLTCP.

    Qualifications

    • High School diploma
    • Minimum 2 Years managed care experience working in provider relations or member services department
    • Amisys, Word, Excel, Smartcare, Argo

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