Key Functions/Responsibilities:
- Initiates the collection of all pertinent information/documentation from Providers and their office staff. Verifies credentials through the appropriate primary sources.
- Independently reviews credentialing files to ensure completion and accuracy of information, per Plan’s policies. Ensures all files are completed in a timely manner, and meet the appropriate turnaround requirements.
- Reviews sanction and exclusion sources to ensure that providers going through initial credentialing or recredentialing process are not currently debarred, suspended or otherwise excluded from participation in Medicare, Medicaid or any other federal or state health care programs.
- Responsible for managing internal provider data queues (e.g. Terminations, Non-Pars).
- Organizes and maintains assigned electronic credentialing files. Responsible for updating provider information within the appropriate databases.
- Maintain detailed log of all pending work.
- Supports special projects and completes other duties, as assigned.
Supervision Received:
- Close supervision is received daily.
Qualifications:
Education:
Preferred/Desirable:
- High school diploma or GED required.
- Bachelor’s degree in healthcare administration, related field, or equivalent combination of education, training and experience is preferred.