SPECIALIST (OBH), PAYOR ENROLLMENT
Company: One Brooklyn Health System
Posted on: November 22, 2021
Under supervision of the Director, the Payor Enrollment
Specialist is responsible for all aspects of the credentialing
process.-- Including, but not limited to maintaining current
information for each provider via the credentialing databases and
online systems.-- Maintain and manage a credentialing work flow to
ensure accurate and timely renewal of licenses and other
certifications. Produce monthly productivity reports as well as ad
hock reports as needed.-- Ability to adjust to a constantly
changing environment.-- This department services the One Brooklyn
Health System and all affiliated physician enrollment services
across three campuses.
- Responsible for enrolling physicians, allied health
professionals and other practitioners in all commercial and
governmental health plans where OBH physicians are contracted.
- Maintains compliance with regulatory and accrediting
- Participates in the ongoing development and implementation of
credentialing processes and procedures.
- Provide process improvement input on the daily workflows and
- Completes provider managed care credentialing and
re-credentialing applications; including Medicare and Medicaid
- Assists with annual payer delegation audits.
- Participate in the development of and adherence to:
- Departmental rules and regulations and Governance bylaws.
- Policies pertaining to medical staff, practitioner/provider and
- Collect and maintain copies of confidential credentials i.e.
current state licenses, DEA certificates, malpractice coverage and
any other required credentialing documents for all providers.
- Inputs data and maintains data integrity for our payor
- Maintains assigned CAQH provider profiles.
- Monitors license and certification expirations for all
providers to ensure timely renewals.
- Maintains and updates department credentialing spreadsheets
biweekly. Provides relevant credentialing information to management
and billing department.
- Analyzes and updates verification information as needed.
- Coordinates monthly conference calls with payors as part of the
department's quality management program.
- Responsible for generating and monitoring credentialing reports
- Assists in denial resolution and root cause analyses specific
to payor alignment and payor enrollment issues.
- Responds to Physician and employee inquiries.
- All other duties as assigned.Education:
- Bachelor's--degree preferred.Experience:
Minimum three (3) years of related
managed care/credentialing experience in a hospital setting
preferred.Knowledge and Skills:
- Must have complete knowledge of the credentialing processes as
it relates to Managed Care, Medicare, and Medicaid.
- Ability to manage multiple projects with proven experience
prioritizing multiple assignments.
- Ability to communicate with all levels of management and
- Excellent attention to detail.
- Ability to research, analyze and collate data.
- Ability to work independently with minimal supervision.
- Ability to establish and maintain effective working
relationships with providers, patients, management, staff and
- Proficient use of Visual Cactus and Microsoft Office
applications (Word, Excel, Access).
- Understanding of the delegated process workflow and requirement
- Ability to effectively navigate CAQH, PECOS and EMEDNY.
- Knowledge of NCQA credentialing standards and JCAHO standards
- Certified Provider Credentialing Specialist (CPCS),
- Or Certified Professional Medical Services Management (CPMSM),
- Position required prolonged periods of sitting and use of a
computer and screen viewing throughout the workday.
- Position will be required to stoop, bend, lift, and carry items
weighing up to 25 pounds.--Reasonable accommodations may be made to
enable individuals with disabilities to perform the essential
functions.--The statements herein are intended to describe the
general nature and level of work being performed by employees, and
are not to be construed as an exhaustive list of responsibilities,
duties, and skills required of personnel so classified.--
Furthermore, they do not establish a contract for employment and
are subject to change at the discretion of--the--One Brooklyn
Health System.--OBHS is an equal opportunity employer, it is our
policy to provide equal opportunity to all employees and applicants
for employment without regard to race, color, religion, national
origin, marital status, military status, age, gender, sexual
orientation, disability or handicap or other characteristics
protected by applicable federal, state, or local laws.
Keywords: One Brooklyn Health System, New York , SPECIALIST (OBH), PAYOR ENROLLMENT, Other , Brooklyn, New York
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