Professional - PES
2-4 Years of experience in end-to-end process of Provider Enrollments/ Insurance Credentialing, Provider Contracting, and Re-Credentialing.
Strong knowledge of US Credentialing
Knowledge of provider credentialing and its direct impact on the practice’s revenue cycle.
Adhere to organizational policies and procedure.
Ability to prioritize and manage work queue.
Knowledge of Microsoft Office (Word, Excel, Outlook).
Excellent written and verbal communications. Essential Functions
Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications.
Maintain internal provider grid to ensure all information is accurate and logins are available.
Update each provider’s CAQH database file timely according to the schedule published by CMS.
Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid etc.
Maintains knowledge of current health plan and agency requirements for credentialing providers.
Sets up and maintains provider information in online credentialing databases and system.
Tracks license and certification expirations for all providers to ensure timely renewals.
Ensures practice addresses are current with health plans, agencies, and other entities.
Store the documents centrally on our secure document management systems.
Periodic update of the document library for credentialing purpose.
Maintain strict confidentiality in accordance with HIPAA regulations and company policy.
Meeting daily/weekly and monthly targets set for an individual
