Description Remote Medical Staff Services Health Care Specialist – Medical Staff Services Delegation /Enrollment- Full-Time Days The Medical Staff Services Health Care Specialist is responsible for coordinating enrollment processes in accordance with the health plan delegated credentialing agreements, policies & procedures, industry best-practices, and regulatory requirements. Responsibilities Facilitates communication between department personnel, health plans and Delegated Credentialing. Coordinates and administers all aspects of provider enrollment, including: Submission of rosters; reconciliation of provider enrollment statuses Ensuring that all providers are accurately enrolled in health plans Monitoring timelines of health plan loading and general response to enrollment requests Interaction with plan representatives regarding enrollment audits; problems and claims resolution; identify fee schedule issues; and addressing potential corrective action plans and monitoring for successful resolution Collection of data from department and physicians: Gathering and reviewing enrollment requests, applications, change forms, and applicable contracts for completeness and accuracy Accountability for accuracy and integrity of the credentialing database Creating and maintaining accurate systems record, demographic updates, and terminations from health plans. Prepares status reports of work performed and next steps. Assisting with delegation oversight audits, as assigned. Participates in team-based problem solving activities and process improvements. Supports all other functions of the medical staff office and performs other duties as assigned by department leadership. Qualifications Bachelors Degree in a health care related field or equivalent work experience Minimum of five (5) years of experience in health plan / health care administration with general knowledge of Medical Staff Office functions. Preferred experience in health plan Provider Relations and/or Health Plan auditing setting, or within a hospitals Delegated Enrollment or Managed Care Enrollment Department Knowledge of NCQA standards (Joint Commission standards a plus) Experience utilizing a credentialing database, required (Verity CredentialStream preferred). Advanced experience in MS Office Suite products, preferred. NAMSS Certified Provider Credentialing Specialist (CPCS), Required or must obtain within two years of hire. Must have a home office set up conducive for remote work and preferably have experience working in a remote environment. Non-Bargaining Unit, 542 – HSO Medical Staff Services – MSH, Mount Sinai Hospital Employer Description Strength Through Diversity The Mount Sinai Health System believes that diversity, equity, and inclusion are key drivers for excellence. We share a common devotion to delivering exceptional patient care. When you join us, you become a part of Mount Sinai’s unrivaled record of achievement, education, and advancement as we revolutionize medicine together. We invite you to participate actively as a part of the Mount Sinai Health System team by: Using a lens of equity in all aspects of patient care delivery, education, and research to promote policies and practices to allow opportunities for all to thrive and reach their potential. Serving as a role model confronting racist, sexist, or other inappropriate actions by speaking up, challenging exclusionary organizational practices, and standing side-by-side in support of colleagues who experience discrimination. Inspiring and fostering an environment of anti-racist behaviors among and between departments and co-workers. At Mount Sinai, our leaders strive to learn, empower others, and embrace change to further advance equity and improve the well-being of staff, patients, and the organization. We expect our leaders to embrace anti-racism, create a collaborative and respectful environment, and constructively disrupt the status quo to improve the system and enhance care for our patients. We work hard to create an inclusive, welcoming and nurturing work environment where all feel they are valued, belong and are able to advance professionally. Explore more about this opportunity and how you can help us write a new chapter in our history! “About the Mount Sinai Health System: Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 43,000 employees working across eight hospitals, more than 400 outpatient practices, more than 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time – discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it. Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients’ medical and emotional needs at the center of all treatment. The Health System includes approximately 7,400 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. We are consistently ranked by U.S. News & World Report’s Best Hospitals, receiving high “Honor Roll” status, and are highly ranked: No. 1 in Geriatrics and top 20 in Cardiology/Heart Surgery, Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 12 in Ophthalmology. U.S. News & World Report’s “Best Children’s Hospitals” ranks Mount Sinai Kravis Children’s Hospital among the country’s best in several pediatric specialties. The Icahn School of Medicine at Mount Sinai is ranked No. 14 nationwide in National Institutes of Health funding and in the 99th percentile in research dollars per investigator according to the Association of American Medical Colleges. Newsweek’s “The World’s Best Smart Hospitals” ranks The Mount Sinai Hospital as No. 1 in New York and in the top five globally, and Mount Sinai Morningside in the top 20 globally. The Mount Sinai Health System is an equal opportunity employer. We comply with applicable Federal civil rights laws and does not discriminate, exclude, or treat people differently on the basis of race, color, national origin, age, religion, disability, sex, sexual orientation, gender identity, or gender expression. We are passionately committed to addressing racism and its effects on our faculty, staff, students, trainees, patients, visitors, and the communities we serve. Our goal is for Mount Sinai to become an anti-racist health care and learning institution that intentionally addresses structural racism.” EOE Minorities/Women/Disabled/Veterans Compensation The Mount Sinai Health System (MSHS) provides a salary range to comply with the New York City Law on Salary Transparency in Job Advertisements. The salary range for the role is $58661 – $78000 Annually. Actual salaries depend on a variety of factors, including experience, education, and hospital need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.
Bachelors Degree in a health care related field or equivalent work experience Minimum of five (5) years of experience in health plan / health care administration with general knowledge of Medical Staff Office functions. Preferred experience in health plan Provider Relations and/or Health Plan auditing setting, or within a hospitals Delegated Enrollment or Managed Care Enrollment Department Knowledge of NCQA standards (Joint Commission standards a plus) Experience utilizing a credentialing database, required (Verity CredentialStream preferred). Advanced experience in MS Office Suite products, preferred. NAMSS Certified Provider Credentialing Specialist (CPCS), Required or must obtain within two years of hire. Must have a home office set up conducive for remote work and preferably have experience working in a remote environment. Non-Bargaining Unit, 542 – HSO Medical Staff Services – MSH, Mount Sinai Hospital
Facilitates communication between department personnel, health plans and Delegated Credentialing. Coordinates and administers all aspects of provider enrollment, including: Submission of rosters; reconciliation of provider enrollment statuses Ensuring that all providers are accurately enrolled in health plans Monitoring timelines of health plan loading and general response to enrollment requests Interaction with plan representatives regarding enrollment audits; problems and claims resolution; identify fee schedule issues; and addressing potential corrective action plans and monitoring for successful resolution Collection of data from department and physicians: Gathering and reviewing enrollment requests, applications, change forms, and applicable contracts for completeness and accuracy Accountability for accuracy and integrity of the credentialing database Creating and maintaining accurate systems record, demographic updates, and terminations from health plans. Prepares status reports of work performed and next steps. Assisting with delegation oversight audits, as assigned. Participates in team-based problem solving activities and process improvements. Supports all other functions of the medical staff office and performs other duties as assigned by department leadership.
