Centers Plan for Healthy Living

  • Credentialing Specialist

    Job Locations US-NY-Farmingdale
    Posted Date 3 months ago(12/3/2018 11:51 AM)
    Provider Services
  • Overview



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    Centers Plan for Healthy Living (CPHL), is a Managed Care Organization servicing members with Medicare and/or Medicaid.  Our goal is to provide members and all those involved in their care with the guidance and health plan choices they need for healthy living. CPHL is committed to providing quality, coordinated health care to some of the most honored and yet still vulnerable members of our community.




    Experienced Credentialing Specialist/Coordinator working in corporate and healthcare office environments. Expertise in coordinating provider applications and the re-credentialing process. Solid Knowledge of credentialing standards.



    • Review provider files for appropriate documentation required for the credentialing process.
    • Prepare files for audits and maintain electronic data input activities.
    • Coordinate credentialing and re-credentialing applications and conduct document research.
    • Collect and maintain files in relation to credentialing of network providers, including application, contracts, current physician licenses, DEA licenses, malpractice insurance, board certifications and other pertinent forms.
    • Prepare documents for Credentialing Committee review.
    • Forward applications to providers and ensured accuracy and completeness of information.
    • Professional interface between plan and provider staff collect required information.
    • Perform credential verification and request information from appropriate data banks.
    • Submit applications to manager, medical director and Credentialing Committee for review.
    • Implement and monitor procedures and activities related to credentialing and re-credentialing of network providers.
    • Communicate with providers and field associates regarding credentialing status.


    Education and Experience:

    Required:   High school diploma or general education degree (GED)

    Preferred:   College experience and or credentialing certification.


    Type of Experience:    

    Required:  Provider Credentialing

    Preferred: Credentialing in a Healthplan setting      




    Required:    None Required

    Preferred: Credentialing Certification


    Knowledge and Skills:

    Verification Websites


    Credentialing Subcommittee Functions


    Proven ability to work independently and efficiently with superior results.This position requires good communication skills, good interpersonal skills and a friendly, pleasant manner. A professional appearance and excellent telephone etiquette is essential. The ability to handle multiple tasks as well as switch tasks is required. Team environment requires a patient and helpful demeanor to assist physicians in credentialing.






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