Credentialing Specialist jobs in Clifton, NJ

PRIMARY FUNCTION

Responsible for the procedures associated with recruitment of Auto/Pip experienced providers into network, which includes receipt, review, and processing of credentialing application and to serve as liaison between the providers and FMCO. As such, responsible for recruitment, communication, and resolution of questions and issues between the provider and the Company.

RESPONSIBILITIES

Recruitment

· Identify and communicate with potential providers via telephone and written correspondence.

· Ensure provider experience and understanding of Auto/Pip

· Attend meetings at providers’ offices relating to recruitment process.

· Maintain and update electronic log of potential providers’ current status in recruitment process.

· Ensure that all documentation is completed to facilitate a smooth credentialing process.

· Provide weekly written report of all activities.

Credentialing

· Interact with potential providers.

· Distribute, assist in completion and collect all credentialing materials.

· Support and facilitate the credentialing process; inform the provider of credentialing status.

· Data entry of provider information into Provider Database.

· Prepare necessary reports for review of Quality Management Committee.

· Assist in collecting information for appeals and sanctioning processes.

Provider Relations

· Identify and interact with potential providers and educate regarding FMCO policy and procedure.

· Act as a liaison between the providers and FMCO.

· Distribute and assist in completion of provider applications and contracts.

· Conduct on-site visits to provider locations, as necessary.

· Ensure that providers are adequately supplied with all necessary forms.

· Maintain the Provider Database.

· Assist in the resolution of provider issues.

· Maintain the Provider QA Database.

· Communicate with the Quality assurance supervisor, as necessary.

· Prepare reports for the Quality Management Committee.

· Assist in provider education program.

· Attend in-services to update skills and information in changes in plans or procedures.

EDUCATION, EXPERIENCE, SKILLS

· Bachelors Degree preferred.

· Previous experience in medical field desirous.

· Previous experience with NJ PIP Fee Schedule and rules desirous.

· Must exercise sound judgment, and possess ability to work with minimum supervision.

· Excellent verbal and written communication skills.

· Excellent negotiation skills.

· Computer proficiency.

· Ability to prioritize duties.

First Managed Care Option, Inc., is an Equal Opportunity Employer and takes pride in maintaining a diverse environment. We do not discriminate in recruitment, hiring, training, promotion or any other employment practices for reasons of race, color, religion, gender, national origin, age, sexual orientation, marital or veteran status, disability, or any other legally protected status.