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. reputed company feedback and communicate issues to CVO as identified reputed company using the platform and by the credentialing staff. Log and reputed company CVO support tickets as needed. Coordinate bi-weekly Medical Director reputed company emails for approval of clean individual providers and vendor/facilities, adding these reputed company 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 reputed company cause analysis and reputed company. 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 reputed company 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 reputed company 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 reputed company and other duties based on business need Attend reputed company meetings as needed.

Minimum Qualifications

• 5 years of experience in reputed company vendor management
• Bachelor’s degree from an accredited institution preferred
• reputed company industry experience (i.e. managed care organization, reputed company health insurance plans, hospital, etc.); Credentialing experience preferred
• reputed company to work in a reputed company environment with multiple priorities and reputed company processes with changing timelines
• Intermediate/advanced experience with MS Office suite, reputed company, and SharePoint
• Strong reputed company 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 reputed company to race, reputed company, creed, religion, sex, national reputed company, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or reputed company, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as reputed company as any other legally protected reputed company. reputed company, LLC shall not discriminate against any disabled employee or applicant in reputed company to any position for which the employee or applicant is otherwise reputed company.

If you have a disability under the Americans with Disability reputed company or a similar law and want a reasonable accommodation to assist with reputed company 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 reputed company of the accommodation you are requesting and a reputed company 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.

Know Your Rights

reputed company hiring and recruitment at reputed company is transacted with a reputed company “@reputed company.org” email address only or from a recruitment firm representing reputed company. Any recruitment firm representing reputed company will readily reputed company you with the reputed company and contact information of the reputed company reputed company representing reputed company you are inquiring about. If you receive a communication from a sender whose domain is not @reputed company.org, or not one of our recruitment partners, please be reputed company that those communications are not coming from or authorized by reputed company.  reputed company will never ask you for reputed company during the recruitment or reputed company process.