Job Summary

Responsibilities:

Prepare and maintain credentialing files and reports for all individual providers including maintenance of credentialing software, provider rosters and spreadsheets to comply with group delegation requirements.
Process and file applications with third party payors according to each payors individual requirements and addresses/corrects discrepancies as requested by payors.
Conduct all follow up steps till payor approval/completion is obtained.
File provider practice change notifications and perform follow up duties till confirmed complete by payors.
Update NPI records according to provider specifications.
Enroll provider in Medicare/Medicaid as prescribed by each program requirements.
Track provider licensure and Board expirations and ensure timely processing CAQH, TMHP and payor updates.
Complete requests for re-credentialing for both providers and facilities.
Accept and process all requests from payers for credentialing information/updates/new contracts and products
Answer questions, process requests from clients & applicants related to credentialing information.
Prepare and maintain facility credentialing files and reports including maintenance of credentialing software, facility rosters and spreadsheets.
Ensure all records meet standards set by carriers as well as FQHC guidelines
Enrolls facilities in Medicare/Medicaid programs.
Address enrollment disconnects with internal and external stakeholders
Assist with EHRS enrollment, tracking and filing
Maintains quarterly payor specific rosters in accordance to CMS standards
Assist in quarterly CAQH mass attestation

Qualifications

Knowledge of medical credentialing and privileging procedures and standards.
Excellent, clear verbal & written communication skills in English
Detail oriented and organizational skills
Ability to focus for extended periods
Ability to investigate and analyze information and draw conclusions.
Ability to process computer data and to format and generate reports.
Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community.
Experience working as part of a remote team.