Job Description

Title: Enrollment & Credentialing Representative

Location: Midtown

Org Unit: Enrollment

Work Days:

Weekly Hours: 35.00

Exemption Status: Non-Exempt

Salary Range: $36.76 - $42.25

*As required under NYC Human Rights Law Int 1208-2018 - Salary range for this role when Hired for NYC Offices

Under supervision, analyzes and resolves problems related to physician enrollment into managed care plans for full time faculty and IPA physicians. Ensures that physicians are linked correctly to plans and products for correct claims payment and revenue. Acts as a liaison between the Managed Care Payers, and the Academic Clinical Providers and their dedicated representatives with the Academic Clinical Departments.

Job Responsibilities

Assists with following up on physician enrollment status with group contracted managed care plans by building effective relationships with plan representatives to ensure that PO faculty and IPA member activities are given priority processing.
Assists in evaluating reported claim problems to determine if problem is related to linkage or other error.
Identifies data disparities between group contracted plan sources and Managed Care database to limit negative impact on revenue, precertification and referral denials and patient procedure cancellations. Works with plan representatives to correct errors.
Identifies delays in credentialing, linkage errors and claims payment problems and works with plan representatives to further identify root causes and resolve problems.
Communicates with our clinical providers and the clinical departments for the detailed collection, review, and compilation of information for new faculty intakes and recredentialing procedures.
Maintains individual physician file folders according to credentialing policies and procedures with initial and recredential applications and credential verifications which are reviewed during delegation audits by managed care plan representatives.
Maintains internal database and external web module database; updates physician information in group contracted managed care plans, Medicare, Medicaid, and non- contracted carriers including demographic information, addresses changes and disenrollments.
Maintains enrollment and credentialing for delegated and non-delegated plans, Medicare, and Medicaid including but not limited to enrollment, disenrollment and demographic changes.
Processes Intake Applications, enters data and follows credentialing policies and procedures for delegation including but not limited to primary source verification.
Reviews Initial and Recredentialing files in preparation for Delegated Managed Care Committee Meetings, Plans and NCQA Audits. Produces status reports and reconciliations to be sent out.

Education

Bachelor's Degree

Experience

At least 1 year of related experience. Knowledge and experience with Excel a must. Able to perform essential functions for reporting purposes and data analysis (ie. Create spreadsheets, insert delete manipulate save data, data sorting filtering for plan-database comparisons and reconciliations). Previous experience in medical professional credentialing. Strong project management skills.

Knowledge, Skills and Abilities

Demonstrated experience with relational database and supporting software including Microsoft Word, Excel and Microsoft Access.
Excellent problem solving, communication and interpersonal skills to effectively mediate and resolve issues in a timely and cost-effective manner.
Demonstrated project management skills.
Demonstrated ability to prioritize workflow to achieve time sensitive goals.

Licenses and Certifications

Working Conditions/Physical Demands

Cornell welcomes students, faculty, and staff with diverse backgrounds from across the globe to pursue world-class education and career opportunities, to further the founding principle of “any person, any study.” No person shall be denied employment on the basis of any legally protected status or subjected to prohibited discrimination involving, but not limited to, such factors as race, ethnic or national origin, citizenship and immigration status, color, sex, pregnancy or pregnancy-related conditions, age, creed, religion, actual or perceived disability (including persons associated with such a person), arrest and/or conviction record, military or veteran status, sexual orientation, gender expression and/or identity, an individual’s genetic information, domestic violence victim status, familial status, marital status, or any other characteristic protected by applicable federal, state, or local law.

Cornell University embraces diversity in its workforce and seeks job candidates who will contribute to a climate that supports students, faculty, and staff of all identities and backgrounds. We hire based on merit, and encourage people from historically underrepresented and/or marginalized identities to apply. Consistent with federal law, Cornell engages in affirmative action in employment for qualified protected veterans as defined in the Vietnam Era Veterans’ Readjustment Assistance Act (VEVRRA) and qualified individuals with disabilities under Section 503 of the Rehabilitation Act. We also recognize a lawful preference in employment practices for Native Americans living on or near Indian reservations in accordance with applicable law.

About Weill Cornell Medicine

Weill Cornell Medicine is committed to excellence in patient care, scientific discovery and the education of future physicians and scientists in New York City and around the world.

The doctors and scientists of Weill Cornell Medicine — faculty from Weill Cornell Medical College, Weill Cornell Graduate School of Medical Sciences, and Weill Cornell Physician Organization—are engaged in world-class clinical care and cutting-edge research that connect patients to the latest treatment innovations and prevention strategies.

Located in the heart of the Upper East Side's scientific corridor, Weill Cornell Medicine's powerful network of collaborators extends to its parent university Cornell University; to Qatar, where Weill Cornell Medicine-Qatar offers a Cornell University medical degree; and to programs in Tanzania, Haiti, Brazil, Austria, and Turkey. Weill Cornell Medicine faculty provide comprehensive patient care at NewYork-Presbyterian/Weill Cornell Medical Center, NewYork-Presbyterian Lower Manhattan Hospital, and NewYork-Presbyterian Queens. Weill Cornell Medicine is also affiliated with Houston Methodist.

At Weill Cornell Medicine, we connect the collective power of our integrated partners in education and research to provide world-class care for our individual patients—#CareDiscoverTeach.

Industry

Healthcare & Social Services

Company Size

10,000+ employees

Headquarters

New York, NY

Year Founded

1898

Website

cornell.edu

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