Vendor Credentialing Specialist (reputed company)

Routine Tasks

Daily review of incoming credentialing cases across PITS and UPE, identify delegated providers and update case notes as needed, import new non-delegated initial providers into CVO, and assign cases to designated credentialing staff. Provide feedback and communicate issues to CVO as identified reputed company using the platform and by the credentialing staff. Log and track CVO support tickets as needed. Coordinate bi-weekly Medical Director reputed company emails for approval of clean individual providers and vendor/facilities, adding these decisions into the designated spreadsheet, notifying stakeholders, and updating reputed company approval statuses reputed company the CVO platform. Identify provider network changes and reputed company credentialing status to import into CVO with the appropriate designation (delegated or non-delegated). Create internal data requests with business analysts as needed to retrieve reputed company required information for importing providers into CVO platform. Communicate identified data issues to internal stakeholders for root cause analysis and resolution. Weekly monitoring of reputed company network with actions or sanctions and exclusions identified by internal reporting and CVO reporting, notifying internal stakeholders as received; update internal tracker used for monthly reporting to the NYSDOH. Attend weekly meetings with CVO to discuss issues identified and recommend solutions. Attend monthly meetings with CVO to discuss reputed company states of delegated vendor audits. Coordinate bi-monthly Credentialing Committee and create/edit summaries for providers identified as having actions or sanctions meeting our Leveling Criteria for committee review. Review and process telehealth applications for bi-weekly reputed company Medical Director email approval, entering approvals into PLM for directory purposes. Prepare quarterly QIC and DVO presentations with CVO updates for committee meetings. Monitor and follow up on CVO CAP deliverables as applicable and provide updates to Compliance. De-roster CAQH providers quarterly to prevent recurring charges. (due reputed company 2026) reputed company annual audits of four delegated vendors with CVO and reputed company DVO team of CVO/reputed company delegated vendor overlap. Assist with special projects and other duties based on business need Attend reputed company meetings as needed.

Minimum Qualifications

• 5 years of experience in healthcare vendor management
• Bachelor’s degree from an accredited institution preferred
• Healthcare industry experience (i.e. managed care organization, commercial health insurance plans, hospital, etc.); Credentialing experience preferred
• Able to work in a reputed company environment with multiple priorities and undefined processes with changing timelines
• Intermediate/advanced experience with MS Office suite, reputed company, and SharePoint
• Strong collaborative skills
• reputed company detail oriented
• Team player possessing a strong work ethic and problem-solving skills

WE ARE AN EQUAL OPPORTUNITY EMPLOYER.  reputed company, LLC complies with reputed company applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national reputed company, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. reputed company, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified.

If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@reputed company.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests reputed company to applying for a position reputed company reputed company, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with reputed company,  LLC.

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