Vendor Credentialing Specialist (Temp)

Description and Requirements

The Vendor Management Specialist manages the relationship for all business services being performed by external vendors as related to credentialing. Management of these vendors include but are not limited to: responding to internal inquiries regarding business needs related to the credentialing verification organization (CVO); keeping internal stakeholders informed of credentialing decisions and issues found within the primary source verification (PSV) process as completed by the CVO; oversight of delegated vendor/entity audits as completed by the CVO; monthly monitoring of provider network; Credentialing Committee preparations including but not limited to agenda, provider summaries, reporting, etc.

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. Provide feedback and communicate issues to CVO as identified when using the platform and by the credentialing staff. Log and track CVO support tickets as needed. Coordinate bi-weekly Medical Director ad-hoc emails for approval of clean individual providers and vendor/facilities, adding these decisions into the designated spreadsheet, notifying stakeholders, and updating all approval statuses within the CVO platform. Identify provider network changes and current 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 all required information for importing providers into CVO platform. Communicate identified data issues to internal stakeholders for root cause analysis and resolution. Weekly monitoring of Healthfirst 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 current 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 Criteria for committee review. Review and process telehealth applications for bi-weekly ad-hoc 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 provide updates to Compliance. De-roster CAQH providers quarterly to prevent recurring charges. (due April 2026) Oversee annual audits of four delegated vendors with CVO and Healthfirst DVO team of CVO/Healthfirst delegated vendor overlap. Assist with special projects and other duties based on business need Attend ad-hoc meetings as needed.

Minimum Qualifications

• 5 years of experience in healthcare vendor management
• Bachelor's degree from an accredited institution preferred
• Healthcare industry experience (i.e. managed care organization, commercial health insurance plans, hospital, etc.); Credentialing experience preferred
• Able to work in a complex environment with multiple priorities and undefined processes with changing timelines
• Intermediate/advanced experience with MS Office suite, DocuSign, and SharePoint
• Strong collaborative skills
• Very detail oriented
• Team player possessing a strong work ethic and problem-solving skills