Responsible for daily operations of the credentialing department. Developed, managed, and monitored processes and procedures to support the credentialing and re-credentialing
Ensure timely renewal of licenses and certifications
Responsible for all aspects of the credentialing, re-credentialing and privileging processes for all medical providers who provide patient care
Prepare credentialing and re-credentialing applications on behalf of physicians/providers for submission to managed care companies and other agencies
Maintain up-to-date for each provider in credentialing databases and online systems
Anticipate any delays in the practitioner's credentialing process and communicate these issues with the team immediately
Maintain necessary logs, lists, records, and current documentation required for physician/provider credentialing and re- credentialing to ensure requirements are met in a timely manner
Contacts medical office staff, licensing agencies, and insurance carriers to complete credentialing and re-credentialing applications.
Ensures compliance with accreditation standards and legal requirements related to the Medical staff.
Communicates status regarding new applicants, privileging requests, special requests that arise.
Accountable for all functions of the healthcare credentialing process to meet the health plan's requirements for employment as contracted medical professionals
Skills Required:
Managed Care Experience
Contract Maintenance and Negotiation
Working with insurance claims clearinghouse preferred (Navicure)
Effectively communicating on the phone with inbound and outbound calls to reach positive resolutions
Excellent communicator
Work smart by multi-tasking
Commitment to Customer Service
Represent our client in a most professional manner