Job Description
Job Description
Responsible for all aspects of the credentialing, recredentialing and privileging processes for all medical providers who provide patient care. Responsible for ensuring providers are credentialed, appointed, and privileged with health plans, hospitals and patient care facilities. Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications.
Essential Job Functions including, but not limited to:
- Compiles and maintains current and accurate data for all providers.
- Completes provider credentialing and recredentialing applications; monitors applications and follows-up as needed.
- Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
- Maintains provider contract files.
- 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.
- Processes applications for appointment and reappointment of privileges
- Tracks license, DEA and professional liability expirations for appointed providers.
- Maintains appointment files, and information in credentialing database.
- Audits health plan directories for current and accurate provider information.
Required Education:
High school diploma or equivalent required. Associate or Bachelor degree preferred.
Skill, Licensure and Knowledge Requirements:
Certification/Licensure: Certified Provider Credentialing Specialist (CPCS) preferred.
File Management and Organization, Excellent Verbal and Written Communication, Proficient Typing, Data Entry, Attention to Detail, Confidentiality, Thoroughness, Experience with Microsoft Word and Excel.
Physical and Mental Requirements:
Handles a multitude of tasks simultaneously and communicates with staff in verbal and written form.
Work Environment:
The work environment characteristics described here are representative of those the employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Moderate noise (i.e. business office with computers, phone, and printers, light traffic).
- Ability to work in a confined area.
- Ability to sit at a computer terminal for an extended period of time.
Travel or Special Requirements:
Driving during the workday as well as local or out of state travel may be required to perform job duties.
Acknowledgement
I read and understand the requirements to fulfill the responsibilities associated with this job description.
I agree to abide by all the duties and responsibilities for the job including and reasonable request from my supervisor. I also understand that I will be evaluated based on these job specific performance standards.