To oversee the complete credentialing process for new and existing providers.
Ensure all provider credentials are verified and maintained according to organizational policies and procedures.
Coordinate with providers to obtain necessary documents and information.
Maintain accurate credentialing records in the credentialing database/system.
Ensure compliance with state, federal, and accrediting body requirements.
Prepare, review, and manage contracts with providers, payers, and other healthcare entities.
Ensure contracts are compliant with organizational standards and regulatory requirements.
Track contract terms, renewals, and expirations.
Serve as a liaison between providers, payers, and internal departments regarding credentialing and contract issues.
Provide training and support to providers and staff on credentialing and contracting processes.
Address and resolve provider inquiries and concerns promptly.
Generate regular reports on the status of credentialing and contracting activities.
Working closely with providers and organizations to provide guidance on compliance. Including responding to inquiries, staying up-to-date on credentialing requirements, and facilitating communication to resolve compliance issues.
To ensure that physician licenses are renewed prior to expiration
To complete primary source verification for new and existing providers to ensure due diligence.
Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications
Maintain contracted Managed Care Organizations, commercial payers, CMS Medicare, Medicaid, PECOS, NPPES, and CAQH tracking log to ensure all necessary portals logins are active and available.
Assist new individual provider in completing application for National Provider Identifier (NPI)
Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases.
Responsible of ensuring provider collected information is current and accurate.
Responsible of coordinating, monitoring, and maintaining the credentialing and re-credentialing process, re-credentialing, and contracting processes with insurance companies.
Keep track of the expiration date for the state DEA license, Board certification, and Malpractice insurance of individual providers.
Job Type: Full-time
Pay: ?10,657.48 - ?20,370.92 per month
Benefits:
Provident Fund
Application Question(s):
What is your current salary?
Experience:
credentialing: 1 year (Preferred)
US Healthcare: 1 year (Preferred)
Work Location: In person
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