Mount Sinai Health System
Provider Data Management & Credentialing Specialist - Mount Sinai Health Partners
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Job Description
- Req#: 3029268
- Bachelors Degree or combination of education and equivalent business experience.
- 2 years minimum in credentialing.
- 2 years minimum in provider operations.
The Provider Data Management and Credentialing Specialist is responsible for ensuring the data integrity for contracted providers. This includes ongoing audit of the provider database, monitoring provider sanctions from regulatory agencies, participation status with payer programs, and other demographic and credentialing and contractual requirements. This individual is responsible for timely and accurate data reporting to management, payers and other business partners.
Qualifications
Non-Bargaining Unit, E01 - Partner MSO Services - MSH, Mount Sinai Hospital
Responsibilities
1. Conducts analysis on data integrity across the departments multiple processes such as Credentialing and Provider Data Management activity.
2. Participates in ongoing sanctions monitoring process for contracted providers in the organization (i.e., FEHBP, OIG, OPMC, etc.).
3. Participates in department activity for any payer initiatives related to provider data veracity and exchange.
4. Participates in project implementation of major changes to the departments processes.
5. Participates in ongoing department process improvement initiatives.
6. Performs related duties and special projects, as assigned.
7. Maintains patient/employee confidentiality in the management of information
8. Observes Mount Sinai Health System compliance policies
9. Implements and maintains established Health Care System policies and procedures.
10. Verifies with multiple primary sources organizations (i.e., New York State DOE, NPDB, ABMS, OIG, etc.) providers status during initial credentialing and recredentialing cycles.
11. Communicates with providers to obtain requisite information to facilitate timely processing and follows up on inquiries from providers, internal departments or payers related to the credentialing processes/data.
12. Coordinates credentialing related data/profiles with various sources (i.e., internal departments, provider groups, etc.) to support credentialing delegated arrangements.
13. Other duties as assigned
About the company
The mission of the Mount Sinai Health System is to provide compassionate patient care with seamless coordination and to advance medicine through unrivaled education, research, and outreach in the many diverse communities we serve.
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