FGP Credentialing/Enrollment Coordinator - Boynton Beach, Florida

Job Skills Summary:  The Coordinator is responsible to set up and maintain all FGP provider profiles for timely provider enrollments as well as accurate interfaces with other NYU systems.  The Coordinator will handle all enrollment processes including intake, credentialing, re-credentialing, direct enrollment, and delegation. This position exercises independent judgment and discretion in administering credentialing processes, resolving complex issues, and ensuring compliance with applicable organizational, payer, and regulatory requirements. 

Primary Responsibilities: 

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  Coordinating with Business Administrators, Departments/Practices and/or Providers to establish and maintain all FGP provider profiles including service, malpractice, billing as well as credentialing and contractual information in Sprovider and CAQH  
  

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  Ensure timely completion of provider profiles with accurate set up for delegation, carve outs / direct enrollment, EPIC Interface as well as NYU Online Directory. Identifying exceptions, escalating complex issues, and recommending resolutions. 
  

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  Review and submit provider’s credentialing and contractual documents to governmental and commercial health plans including corresponding carve out / direct enrollment vendors 
  

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  Track and monitor the end to end enrollment process of providers regularly to ensure timely communication of possible delays or issues to all stakeholders 
  

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  Manage departmental inbox to ensure inquiries and requests from NYU Business Administrators, Departments/ Practices, Central Billing Offices, external vendors and payers are reviewed and addressed in a timely manner 
  

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  Work with Senior Cred Coordinator or Specialist to resolve all enrollment issues in a timely manner 
  

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  Assist Senior Cred Coordinator or Specialist to prepare reports for timely and accurate enrollments, re-certification/re-credentialing, as well as demo updates/terminations 
  

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  Assist Senior Cred Coordinator or Specialist to review/reconcile rosters to ensure accurate contract linkages set up in Sprovider 
  

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  Interpreting credentialing policies and regulatory requirements for internal processes. 
  

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  Other tasks and projects as assigned which support the business needs of Faculty Group Practice. 
  

Minimum Qualification 

Bachelor’s degree preferred with three (3) years’ experience working in credentialing, managed care, or healthcare management or equivalent. 

Knowledge in managed care and governmental contracting/claims processes preferred 

Excellent computer skills, proficient in Microsoft Excel, knowledge of Sprovider preferred 

Ability to analyze credentialing/ enrollment data and prepare reports/summary 

Excellent organizational skills; ability to prioritize and keep tasks per schedules  

Self-starter; high initiative; able to work both autonomously/ independently and as a team member  

Strong written and verbal communication skills, able to partner with all level of staff, both inside and outside of FGP department