Provider Enrollment and Credentialing Specialist

Location
Stony Brook, NY
Posted
May 05, 2017
Institution Type
Four-Year Institution
Job Description

Provider Enrollment and Credentialing Specialist-1700921

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Summary

The Managed Care Department of Stony Brook Medicine (“SBM”) seeks a Provider Enrollment and Credentialing Specialist with the skills and competency to gather, analyze and format data, information and documentation required by health care plans and payors to credential and enroll clinicians at Stony Brook Medicine as participating providers in their respective plan and payor products.


Duties of a Provider Enrollment and Credentialing Specialist may include the following but are not limited to:

  • Act as liaison between SMB clinical providers, clinical practice plan staffers and healthcare plans and payors (predominantly but not exclusively managed care companies) in addressing a variety of issues relative to the status of those clinical providers as credentialed and enrolled with the plans and payors.
  • Gather, analyze and format data, information and documentation required by health care plans and payors to credential and enroll clinicians at Stony Brook Medicine as participating providers in their respective plan and payor products.
  • Act as liaison between SMB clinical providers, clinical practice plan staffers and healthcare plans and payors (predominantly but not exclusively managed care companies) in addressing a variety of issues relative to the status of those clinical providers as credentialed and enrolled with the plans and payors.
  • Establish and maintain clinical provider files, collect and organize necessary data, information and documents regarding licensure, professional status and associations, regulatory and legal activities, clinical activities, and related subject matter, and format and maintain such data and information in an electronic database.

Qualifications


Required Qualifications:

Bachelor's Degree. One (1) year of experience enrolling and credentialing clinical providers, including physicians, either within a health care delivery organization or on behalf of a health care plan or payor such as a managed care organization; or one (1) year of prior clinical experience in a Hospital or provider office. Familiarity with federal and state regulatory and clinical standards (TJC, NCQA).


Preferred Qualifications: MBA, MHP, MPA or equivalent advanced degree. Enrollment and credentialing experience on behalf of a health care delivery system (hospital or physician practice group), particularly an academic medical center, is preferred. Experience with CACTUS or similar database software.



Special Notes: Stony Brook Medicine is a smoke free environment. Smoking is strictly prohibited anywhere on campus, including parking lots and outdoor areas on the premises.

This function/position has been designated as “essential.” This means that when the Hospital is faced with an institutional emergency, employees in such positions may be required to remain at their work location or to report to work to protect, recover, and continue operations at Stony Brook Medicine, Stony Brook University Hospital and related facilities.

All Hospital positions are subject to changes in pass days and shifts as necessary. This position may require the wearing of respiratory protection, which may prohibit the wearing of facial hair.

The selected candidate must successfully clear a background investigation. Prior to start date, the selected candidate must meet the following requirements: Successfully complete pre-employment physical examination and obtain medical clearance from Stony Brook Medicine's Employee Health Services (The hiring department will be responsible for any fee incurred for examination), submit (3) written references, and provide a copy of any required New York State license(s)/certificate(s). Please be advised that failure to comply with any of the above requirements could result in a delayed start date and/or revocation of the employment offer.


Pursuant to Executive Order 161, no State entity, as defined by the Executive Order, is permitted to ask, or mandate, in any form, that an applicant for employment provide his or her current compensation, or any prior compensation history, until such time as the applicant is extended a conditional offer of employment with compensation. If such information has been requested from you before such time, please contact the Governor’s Office of Employee Relations at (518) 474-6988 or via email at info@goer.ny.gov.


About Stony Brook Medicine:

The best ideas in medicine start with the best people. At Stony Brook Medicine, our highest calling is to put the power of ideas to work in our patients’ lives. Stony Brook Medicine integrates and elevates all of our health-related initiatives: education, research and patient care. Stony Brook Medicine is Long Island’s premier academic medical center. With 603 beds, we serve as the region’s only tertiary care center and Level 1 Trauma Center, and are home to the Stony Brook Heart Institute, Stony Brook Cancer Center, Stony Brook Children’s Hospital, Stony Brook Neurosciences Institute, and Stony Brook Digestive Disorders Institute. We also encompass Suffolk County’s only Level 4 Regional Perinatal Center, state-designated AIDS Center, state-designated Comprehensive Psychiatric Emergency Program, state-designated Burn Center, the Christopher Pendergast ALS Center of Excellence, and Kidney Transplant Center. It is home of the nation’s first Pediatric Multiple Sclerosis Center.

Stony Brook University is an Affirmative Action/Equal Opportunity employer. We are committed to the creation of a diverse and inclusive campus climate. We encourage protected veterans, individuals with disabilities, women and minorities to apply.


IF YOU NEED A DISABILITY-RELATED ACCOMMODATION, PLEASE CALL THE UNIVERSITY HUMAN RESOURCE SERVICES DEPARTMENT AT (631) 632-6161 OR THE UNIVERSITY HOSPITAL HUMAN RESOURCES DEPARTMENT AT (631) 444-4700.
IN ACCORDANCE WITH THE TITLE II CRIME AWARENESS AND SECURITY ACT, A COPY OF OUR CRIME STATISTICS IS AVAILABLE UPON REQUEST BY CALLING (631) 632-6350. IT CAN ALSO BE VIEWED ON-LINE AT THE UNIVERSITY POLICE WEBSITE AT http://www.stonybrook.edu/police


Official Job Title: TH Instructional Support Associate
Job Field: Administrative & Professional (non-Clinical)
Primary Location: US-NY-Stony Brook
Department/Hiring Area: Managed Care-Stony Brook University Hospital
Schedule: Full-time Day Shift 8:30 am to 5:00 pmManaged Care-Stony Brook University Hospital
Posting Start Date: May 4, 2017
Posting End Date: Jun 3, 2017, 10:59:00 PM
Salary: Commensurate with experience
Salary Grade: SL2

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