Job Summary:

• Collects, reviews, audits, and processes enrollment of Medical Staff professionals in accordance with all government rules and regulations
• Closely monitors and ensures timely follow-up for information collection and pursues additional information
• Provides technical and administrative support to the departments and clinics as it relates to enrollment with Medicare and Medicaid
• Creates, monitors and updates policies and procedures related to departmental assignments and duties
• Complete credentialing & re-validation paperwork timely to ensure continued business with existing partners.
• Complete LOIs, enrollments and applications for new business with potential partners.
• Maintain thorough records of upcoming re-validations to ensure company compliance and timeliness
• Serve as a liaison between internal and external parties during initial development stages.
• Provide thorough compliance research (contracting opportunities, requirements, etc.)
• Monitor and track standard compliance reports regularly
• Take ownership of assigned tasks and communicate status to management at a high level.  

Skills on Resume: 

• Regulatory Knowledge (Hard Skills)
• Attention to Detail (Soft Skills)
• Technical Proficiency (Hard Skills)
• Policy Development (Hard Skills)
• Administrative Skills (Hard Skills)
• Communication (Soft Skills)
• Compliance Monitoring (Hard Skills)
• Project Management (Hard Skills)

Job Summary:

• Implement Provider Credentialing policies and procedures in accordance with Health Plan accreditation standards and federal and state statutes.
• Ensure provider credentialing files are prepared and maintained according to guidelines set forth by department, states, and NCQA standards.
• Coordinate the process of initial credentialing/re-credentialing of providers, including physicians, mid-levels, and facilities.
• Suggest methods to improve the efficiency of the credentialing process.
• Act as liaison between credentialing agencies and providers, communicating directly with providers regarding credentialing status.
• Coordinate validation of providers’ credentialing data through review of physician and other provider applications and research of regulatory bodies
• Participate in appropriate meetings and committees relative to position responsibilities.
• Provide support for NCQA surveys and delegated credentialing arrangements.
• Coordinate and communicate with other departments regarding credentialing processes and/or requirements.
• Research, analyze, and respond to providers’ inquiries, as well as issues raised by internal personnel, providing timely solutions to problems.
• Participate in concurrent monitoring, collection, and update of time-sensitive Provider and Practitioner information.

Skills on Resume: 

• Attention to Detail (Soft Skills)
• Process Improvement (Hard Skills)
• Effective Communication (Soft Skills)
• Organizational Skills (Soft Skills)
• Research and Analytical Skills (Hard Skills)
• Collaboration (Soft Skills)
• Project Management (Hard Skills)

Job Summary:

• Utilize web-based resources and systems to assist with research and verification of providers’ credentialing information for quality assurance and risk management.
• Maintain accurate and appropriate database records on all Provider and Practitioner profiles.
• Ensure the protection of WPS hardware, software, information, and data by complying with system security requirements contained in WPS Information Security Policy.
• Ensure confidentiality of assigned passwords.
• Ensure protection of privacy and confidentiality of provider data.
• Process primary verification data during the credentialing and re-credentialing of providers.
• Prepare verification letters.
• Maintain database for provider credentialing and re-credentialing.
• Contact medical office staffs, licensing agencies and insurance carriers to complete credentialing and re-credentialing applications.
• Handle confidential information in an appropriate manner.
• Support OPPE and FPPE processes.

Skills on Resume: 

• Research and Verification Skills (Hard Skills)
• Database Management (Hard Skills)
• Information Security (Hard Skills)
• Confidentiality and Privacy (Soft Skills)
• Credentialing and Re-Credentialing (Hard Skills)
• Communication Skills (Soft Skills)
• Detail-Oriented (Soft Skills)
• Support for OPPE and FPPE (Hard Skills)

Job Summary:

• Review onboarding applications from HR for completeness and accuracy.
• Develops credentialing workflows, processes, & policy/procedures for the department including, but not limited to, creating Job Aids, Quick Reference Guides, and FAQ's for internal & external stakeholders.
• Assure compliance with and implement policies/procedures for the accurate and timely processing of credentialing applications for providers and facilities.
• Monitor & notify providers of upcoming expiring certifications, including licensures, and all other state and national required documents necessary for the practitioner and/or facility to legally and ethically perform under scope of practice.
• Develops and creates weekly reports of the credentialing process utilizing Newport's tracking and revenue reports.
• Completes certification/licensure registry checks to ensure compliance with contractual credentialing standards.
• Responsible for various assigned workflows and daily/weekly/monthly duties.
• Conducts roster reconciliations and assists with audits.
• Creates & updates CAQH provider profiles.
• Completes credentialing applications for third parties and organizes credentialing application packages.

Skills on Resume: 

• Attention to Detail (Soft Skills)
• Process Development (Hard Skills)
• Compliance Management (Hard Skills)
• Reporting and Analysis (Hard Skills)
• Communication Skills (Soft Skills)
• Database Management (Hard Skills)
• Audit and Reconciliation (Hard Skills)
• Organizational Skills (Soft Skills)

Job Summary:

• Ensures certification/licensures are up-to-date and loaded into the tracking system for credential-eligible providers.
• Enters large volumes of data entry accurately for credentialing apps & CAQH database and in a timely manner.
• Conducts roster reconciliations.
• Creates & updates CAQH provider profiles.
• Completes credentialing applications for third parties and organizes credentialing application packages.
• Supports the Contracts and Compliance teams.
• Assist with the Peer Review process and oversight with sites.
• Responsible for aligning job descriptions appropriately with payor and State & Federal requirements.
• Participates in team meetings to assist and help implement ways to continually improve the credentialing process.
• Assists in training of new Credentialing Specialists and support staff.
• Identifies, corrects and communicates issues with individual or group files, processes and programs.

Skills on Resume: 

• Attention to Detail (Soft Skills)
• Data Management (Hard Skills)
• Compliance Knowledge (Hard Skills)
• Organizational Skills (Soft Skills)
• Process Improvement (Soft Skills)
• Training and Support (Soft Skills)
• Problem-Solving (Soft Skills)
• Collaboration and Communication (Soft Skills)

Job Summary:

• Promotes compliance with company policies and procedures as well as local, state and federal requirements to meet AAAHC and NCQA standards for health care professionals employed and contracted to provide services for Premise Health.
• Manages all employment credentialing to include collection, verification and ongoing maintenance of essential documents for all employed or contracted healthcare professionals providing services for Premise Health.
• Ensures timely completion of credentialing, privileging and re-credentialing activities for all employed and contracted Health Care Professionals.
• Obtains and verifies current copies of all Health Care Professionals' credentials/essential documents prior to start date.
• Primary source verifies essential documents for all Health Care Professionals.
• Document preparation, execution, distribution and verification of Practice Agreements and regulatory filings for all Nurse Practitioners and Physician Assistants employed or contracted to provide services with Premise Health.
• Communicates approval of credentialing, privileging and practice agreements to providers and managers.
• Maintains internal Health Care Professional files including obtaining current/updated copies of essential documents, loading/scanning all documents, and updating individual files in company credentialing software/files.
• Acts as liaison with Hiring Manager, Human Resources, Talent Acquisition, Operations and Health Care Professional.
• Provides administrative support to the Credentialing Director.
• Participates in weekly Credentialing Committee Meetings to present files and information to the committee for approval as well as topic discussions and approvals.

Skills on Resume: 

• Credentialing Management (Hard Skills)
• Regulatory Knowledge (Hard Skills)
• Document Verification (Hard Skills)
• Effective Communication (Soft Skills)
• Administrative Support (Hard Skills)
• Attention to Detail (Soft Skills)
• Organizational Skills (Soft Skills)
• Interpersonal Skills (Soft Skills)

Job Summary:

• Professionally represent client as client billing office
• Adhere to defined department goals and activity metrics
• Complete provider credentialing and re-credentialing applications and monitor applications and follow-up
• Maintain electronic copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers in a network drive
• Maintain knowledge of hospital-specific requirements for credentialing providers
• Set up and maintain provider information in online credentialing databases and systems
• Track license, certification, and liability expirations for all providers to ensure receipt of renewals
• Coordinate with managed care providers and physicians to complete the credentialing process, including any additional documentation, verifications, references, and applications necessary
• Ensure credentialing deadlines are met
• Communicate with clients regarding the status and timeline of the credentialing process for providers
• Complete and review all applications to ensure accuracy prior to submission
• Comply with state/federal regulations and adhere to HIPAA and PHI guidelines

Skills on Resume: 

• Credentialing Management (Hard Skills)
• Regulatory Knowledge (Hard Skills)
• Detail Orientation (Soft Skills)
• Organizational Skills (Soft Skills)
• Communication (Soft Skills)
• Time Management (Soft Skills)
• Problem-Solving (Soft Skills)
• Client Representation (Soft Skills)

Job Summary:

• Support Director of Medical Staff Services in everyday functions of Medical Staff Affairs.
• Maintenance of Physician Information in the Provider Dictionary.
• Assist in the preparation of Credentialing Documents required for Medical Staff Meetings.
• Responsible for the upkeep of the Physician Call Schedule.
• Participation in calls with CPC/Parallon, Division, and Corporate Credentialing Initiatives.
• Actively seeks ways to control costs without compromising patient safety, quality of care, or the services delivered.
• Promotes positive customer service with internal and external customers.
• Understanding of the credentialing processes as it relates to medical billing including electronic remittances, service locations, and other details that could impact reimbursement.
• Primary source verification for resolving issues concerning the provider’s enrollment with insurance companies.
• Ensures timely completion of credentialing and re-credentialing of providers for all insurance carriers.

Skills on Resume: 

• Credentialing Processes (Hard Skills)
• Attention to Detail (Hard Skills)
• Organizational Skills (Soft Skills)
• Communication (Soft Skills)
• Cost Control (Hard Skills)
• Billing Knowledge (Hard Skills)
• Problem Resolution (Soft Skills)
• Timeliness (Soft Skills)

Job Summary:

• Respond to requests for initial application packets for Medical Staff and Allied Health Professional (AHP) membership and privileges to potential physician and Allied Health Professional members within 24 hours.
• Responsible for primary source verification of new physician and/or Allied Health Professional applications to the Medical Staff or Allied Health Professional staff.
• Responsible for the processing of physician and AHP applications in an accurate and timely manner (approximately three (3) months and according to TJC standards, Medical Staff Bylaws, the Credentialing Policy, and the Policy on Allied Health Providers.
• May process requests for expedited clinical privileges/activities for new applicants and other temporary privileges as well as requests for increases in privileges, in an accurate and timely manner.
• Responsible for the completion of physician and/or AHP initial/provisional/ reappointment application files. 
• Follow through with the actions of the Board of Directors concerning applications in a timely and concise manner in order to complete each file and notify proper areas within the medical center.
• May be responsible for maintenance of expirable credentials of Medical Staff members and AHP’s, in the credentialing software program, and in the practitioner’s file.
• Participates in the preparation of files and other activities related to regulatory surveys.
• Makes suggestions to the Manager, Medical Staff Services for revisions to the Medical Staff Bylaws, policies, and procedures concerning the credentialing/ re-credentialing process as appropriate.
• May prepare for and follow through with the monthly Credentials Committee meetings. (Agenda, meeting notices, minutes).
• May prepare monthly credentials report for the Medical Executive Committee and the Board of Directors/Executive Board.

Skills on Resume: 

• Credentialing Expertise (Hard Skills)
• Detail Orientation (Hard Skills)
• Time Management (Soft Skills)
• Effective Communication (Soft Skills)
• Organizational Skills (Soft Skills)
• Regulatory Knowledge (Hard Skills)
• Problem-Solving (Soft Skills)
• Technical Proficiency (Hard Skills)

Job Summary:

• Assist VWI RCM in completing and updating BCBA credentialing profiles for each provider, and the business entity to whom credentialing services are provided.
• Review provider applications for completion and accuracy, ensure timely and accurate follow-up and monitor and report on the credentialing progress of each practitioner.
• Lead, coordinate, and monitor the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility.
• Conduct research and primary source verification of all components of the application file.
• Assist providers with credentialing and re-credentialing applications, monitor applications, and follow-up
• Review credentialing applications and new profiles may be initiated upon receipt of a signed copy of a standard credentialing implementation form.
• Track funding source certification expirations for all providers to assist with timely renewals.
• Maintain copies of current state licenses, certificates, malpractice coverage, and any other required credentialing documents for all providers.
• Track the expiration of certifications, maintain up-to-date files, and assist providers and customers with phone inquiries.
• Maintain corporate provider contract files.
• Obtains appropriate credentials as well as updated copies prior to the expiration date of any license, certification, or other required documentation.
• Acts as liaison with Practitioners, billing management, and insurance carriers.

Skills on Resume: 

• Credentialing Management (Hard Skills)
• Accuracy Verification (Hard Skills)
• Research Skills (Hard Skills)
• Application Assistance (Soft Skills)
• Expiration Tracking (Hard Skills)
• File Maintenance (Hard Skills)
• Communication (Soft Skills)
• Reporting (Hard Skills)

Job Summary:

• Update health plan directories with accurate information about participating clinics and providers.
• Ensure practice addresses are current with health plans, agencies, and other entities.
• Set up and maintain provider information in online credentialing databases and systems.
• Create and maintain provider credentialing files within internal electronic tracking systems.
• Assist with maintaining the Council for Affordable Quality Healthcare (“CAQH”) database.
• Assist in maintaining the information necessary to complete CAQH profiles for downloading credentialing data.
• Assist with completing CAQH applications in preparation for Credentialing with Insurance.
• Maintain timely and accurate data entry, and periodically revise provider data in the department records
• Maintain provider demographic and electronic data files
• Use CAQH system to submit provider data by health plans.
• Maintain knowledge of current health plans and agency requirements for credentialing providers.

Skills on Resume: 

• Accurate Data Entry (Hard Skills)
• Credentialing Systems (Hard Skills)
• Detail-Oriented (Soft Skills)
• Regulatory Compliance (Hard Skills)
• Organizational Skills (Soft Skills)
• Effective Communication (Soft Skills)
• Time Management (Soft Skills)
• Technical Expertise (Hard Skills)

Job Summary:

• Maintains internal files including copies of current credentials and loads/scans all documents into the credentialing database.
• Assists in all areas of Managed Care Contracting, reimbursement/billing, and human resources/talent acquisition.
• Manage Provider Credentialing Process
• On-board all New Hire & Acquisition doctors
• Set up and maintain all credentialing requirements & documentation in the credentialing database.
• Provide weekly tracking reporting on the credentialing status
• Manage all doctor CAQH applications and ensure completeness with the required information.
• Manage Annual Provider License, DEA & Control Substance documentation & Renewal process
• Reporting/Auditing and managing Expires
• Maintain various credentialing reports
• Maintain accurate provider profiles on CAQH and MyEyeDr. Credentialing database.

Skills on Resume: 

• Database Management (Hard Skills)
• Credentialing Knowledge (Hard Skills)
• Document Management (Hard Skills)
• Reporting and Auditing (Hard Skills)
• Project Management (Hard Skills)
• Communication (Soft Skills)
• Attention to Detail (Soft Skills)
• Problem-Solving (Soft Skills)