Description & Requirements
Essential Duties and Responsibilities:
- Process applications and initial as well as re-credentialing paperwork.
- Maintain knowledge of current health plan requirements for credentialing providers including managing delegated health plans.
- Complete provider credentialing and recredentialing applications in accordance with guidelines; monitor applications and follow up as needed.
- Set up and maintain provider information in online credentialing databases and system.
- Collect credentials of incoming providers as per work instructions.
- Perform primary source verifications of all practitioner credentials.
- Perform data enter into various systems used to credential and recredential staff.
- Maintain necessary logs, lists, records, and current documentation required for provider credentialing.
- Provide regular reports on pending staff and those who have cleared credentialing.
- High school Diploma or GED required.
- Preferred: one year experience working with CPT/medical coding.