Responsibilities
- Manage the medical credentialing process for healthcare providers, ensuring compliance with CMS guidelines and other regulatory requirements.
- Coordinate credentialing and re-credentialing applications, including gathering necessary documentation and verifying credentials.
- Maintain accurate and up-to-date provider information in credentialing databases and EMR systems.
- Communicate with healthcare providers, insurance companies, and other stakeholders to resolve credentialing-related issues.
- Stay informed about changes in healthcare regulations and credentialing requirements to ensure compliance.
- Assist in conducting audits and quality assurance activities related to credentialing processes.
- Collaborate with internal teams to support population health initiatives and Value Based Reimbursement (VBR) calling protocols.
- Provide administrative support to the clinical team and other departments as needed.
- Manage incoming and outgoing communications, including emails, phone calls, and faxes.
- Assist with data entry and recordkeeping tasks to ensure accuracy and completeness of information.
- Perform additional duties as assigned.
Screening Criteria
- Bachelor’s degree in a related field or an equivalent combination of education and related work experience.
- At least two (2) years of experience in medical credentialing or related healthcare administrative role.
- Must have a stable employment history.
