Credentialing Analyst & Billing Associate.

Founded in 1866, The Floating Hospital (TFH), is one of the last remaining charity hospitals in New York City. Our commitment is the same as it was more than 150 years ago: unrestricted healthcare to all who walk through our doors, regardless of immigration and insurance status, or the ability to pay. The Floating Hospital welcomes individuals of all ages, from infants, school age children (5+), youth and adults. TFH is a Federally Qualified Health Center and the largest provider to homeless families living in family shelters and domestic violence safe houses throughout all five boroughs.

• Completes applications and maintain all information up to date in Council for Affordable Quality Healthcare (CAQH) for all providers and facilities and attest providers as needed.
• Responsible for credentialing of facilities and providers for insurance companies.
• Prepares and maintains credentialing files and reports for all providers including maintenance of credentialing software through Athena, facility & provider rosters, and spreadsheets to comply with group delegation requirements.
• Accepts and processes all requests from payers for credentialing information, updates.
• Answers questions, process requests from staff/providers related to credentialing information.
• Coordinates with TFH leadership to prepares for and coordinate credentialing audits in compliance with payer credentialing contracts.
• Monitors and reports turnaround times for processing of credentials applications, with continued focus on delivery of a high-quality output, with the greatest efficiency, in the least amount of time.
• Files applicable provider practice change notifications and performs follow up duties until confirmed complete by payers.
• Updates facility and provider NPI records according to provider specifications.
• Ensures that established executed contracts are properly maintained and circulated as necessary.
• Compiles and maintains current and accurate MCO relevant facility credentialing information.
• Compiles and maintains current and accurate data for all licensed healthcare professionals.
• Completes provider and facility credentialing and re-credentialing applications; monitors applications and provides follow-up as needed.
• Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers
• Enters and maintains individual provider and facility information in online credentialing databases including Athena and Microsoft Excel.
• Tracks contract expirations and continuations with all MCOs to ensure timely renewals and inclusion of all lines of business, including Medicaid, Medicare and Commercial
• Reconcile the monthly provider rosters to ensure new providers are added and terminated providers are removed from The Floating hospital NPI.
• Maintain ETIN Certifications for individual providers and facility locations.
• Works closely with Human Resources to maintain and verify provider licensure, training and certifications with the insurance plans.
• Collaborate with internal departments to resolve any credentialing issues or discrepancies.
• Maintain files for yearly audits.
• Maintains knowledge of current health plan and agency requirements for credentialing providers.
• Assist with Billing claims project as assigned.
• Any other duties that may be assigned.

High school diploma required. Attention to detail required. Must be able to work in a fast-paced environment, be highly organized, and be able to multi-task. Should have experience working with all levels of management.

Must possess strong computer skills and have experience working with computer programs relevant to the nonprofit sector. Knowledge of Athena PM system a plus+

Knowledge and proficiency with New York State Medicare (PECOS) and New York State Medicaid (eMedNY) and NPPES guidelines and requirements.

This is a Hybrid position.