TractManager
  • Lynbrook, NY, USA
  • Hourly
  • Full Time

Health, Dental, Vision, 401K, Life Insurance, PTO


Do you learn quickly and want to help make a difference in the healthcare industry? Do you enjoy working with numbers and solving pressing business challenges? Do you have a basic understanding of the doctor credentialing and enrollment process?   

If so, this may be the perfect role for you! Please review the details below and click "Apply" today if this role excites you as a potentially amazing fit!

 

Position Purpose:

  • The Delegation Specialist role at our Newport Credentialing Solutions division will handle all facets of the enrollment process for delegated plans, including acquiring participation status and pin entry.

Education & Experience:

  • Education: High school diploma or GED required; Associates Degree is preferred
  • Experience: Enrollment experience in the healthcare industry is preferred

Licenses & Certifications Desired:

  • None

Competencies & Work Style:

  • Highly self-motivated, preferably with some experience in the healthcare physician credentialing, expirables management, re-credentialing, provider enrollment environment, medical insurance claims or medical industry in general
  • Success-driven and results-oriented, with the ability to implement and manage cross-functional projects
  • Proficiency with credentialing systems and learns new systems/processes quickly
  • Ability to interact effectively with a variety of people (such as physicians and medical staff offices) and be an excellent "ambassador" for the company
  • Provides highest level of customer service for both internal and external customers
  • Strong written and verbal communication skills, along with strong presentation and client interaction skills
  • Ability to prioritize tasks and projects
  • Accurate discernment on when to act independently and when to ask for guidance and/or assistance
  • Consistently demonstrates flexibility, a customer-focus, terrific organizational skills and a passion for details

 

Responsibilities & Essential Functions:

  • Prepare and submit spreadsheets to health insurance plans to ensure provider participation.
  • Update various databases to ensure proper tracking of enrollments and update requests.
  • Maintain necessary records of outstanding submissions and requests.
  • Verify physician/provider information by searching third party databases
  • Update the company/third party databases with the physician/provider's ID number and start date.
  • Maintain familiarity and stay current with health insurance plans' procedures
  • Coordinate all facets of credentialing, including managed care enrollment and credentials monitoring.
  • Coordinate all managed care credentialing activities to ensure provider participation status. Credentialing activities require substantial contact with outside agencies.
  • Maintain necessary logs, lists, records, and current documentation required for physician/provider credentialing and re-credentialing
  • Verify physician/provider information for managed care plans including communication with health plan representative and other staff as necessary.
  • Follow-up with managed care companies to ensure expedient credentialing.
  • Research and solve credentialing/re-credentialing problems. Perform a variety of routine clerical functions and projects as assigned
  • Maintain relationships with external managed care organization and clients as required.
  • Provides highest level of customer service for both internal and external customers.
  • Have a thorough understanding of company policy and processes, being able to adjust to fast paced, ever changing demands of the insurance industry in or to always be up to the minute with the latest information.
  • Works with Account Managers & team leads in all phases of delegation and accurate entry & submission of credentialing information to payers
  • Ability to prioritize tasks and projects assigned to staff to meet deadlines and, the discretion to know when to act independently and when to ask for guidance and/or assistance.
  • Remains current on policies affecting provider enrollment credentials & delegated clients/payers
  • Performs database and computer functions as required.
  • Perform a variety of routine clerical functions and projects as assigned.

 

Work Environment & Physical Demands:

  • This is a largely sedentary role; however some filing is required, which would require the ability to lift files, open filing cabinets and bend or stand on a stool as necessary
  • This job operates in a clerical, office setting
  • This role routinely uses standard office equipment such as computers, phones, copiers, filing cabinets and fax machines. 
  • This position does not require travel
  • This is a full-time, 40-hour per week position, and typical work hours are Monday through Friday 8:30am-5pm, or 8am-4:30pm, although project support may require temporary adjustments to those hours only as needed
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