HEALTH PLAN CREDENTIALING REPRESENTATIVE

SUMMARY: Position to provide support to the health plan credentialing department. Focus shall be in the area of Medical, Dental and Behavioral Health credentialing and re-credentialing. Shall assist with other business development initiatives as needed. REQUIREMENTS: Ensure all aspects of health plan credentialing are attended to on a daily basis. Tasks to include but are not limited to: completing staff applications for individual plans, use of the Cactus system, PECOS, E-MEDNY, CAQH, Roster Management, and follow-up with all plans on a routine basis. Shall alert health plans of provider additions and provider terminations. Upon termination notification, ensure that patients are moved to another primary care provider at the same location. Review all in-coming mail and process as applicable Shall work closely with contracting department and obtain contract updates/plan changes Shall assist with plan audits as a result of established delegated agreements Shall assist with answering phones, faxing, scanning, form completion etc as needed. Shall communicate with sites on an as needed basis Shall attend meetings and conferences as assigned and report on major points, actions resolved or to be taken. Assist with resolution of operational problems with payers credentialing processes Anticipates department needs by gathering reports, correspondence, maintaining data files or obtaining any and all pertinent information required for departmental deliverables. Informs Coordinator of operational problems. May be asked to assist on special projects within the Business Development Department Other duties as assigned QUALIFICATIONS: High School Diploma or equivalent required Minimum 2 years of experience in healthcare credentialing or 1 year experience in health plan credentialing and 1 year medical billing experience. Experience in Article 28 or Federally Qualified Health Center preferred. Equal Employment Opportunity/Affirmative Action: The Institute for Family Health is an Equal Employment Opportunity Employer. This job summary is intended to be brief and may not list all the duties and functions required, however, it does highlight the essential requirements. Nothing outlined in this job summary is to be construed as an express or implied contract of employment. Please visit www.Institute.org for more information.

Location: New Paltz, NY, US

Posted Date: 5/5/2025