This dual position, both monitoring and operational, is responsible for both increasing the number of provider credentialing files brought to the Credentialing Committee and the monitoring, analysis and completion of the following department activities.
Essential Functions & Responsibilities
- Receive and process all credentialing/re-credentialing applications according to company policies, procedures and processes, as needed
- Coordinate with Credentialing manager for prioritizing routine activities and activities to meet new business needs
- Provide monthly monitoring of multi-state Medicare/Medicaid Sanctions to meet all regulatory, accreditation and contracted client’s requirements
- Provide continuous monitoring, downloading, verifying and filing of expired credentialing documents: license, DEA and insurance documents
- Perform accreditation required, Level 2 audit for all provider credentialing files prepared by Credentialing Coordinators
- Complete credentialing files for committee, as needed
- Contribute to Credentialing Department meeting agenda for continuous staff in-servicing
- Assists in CRC meeting preparation
- Maintain strict level of confidentiality for all matters pertaining to provider credentials and proprietary information
- Ensure compliance with department and company adopted policies/procedures/processes, programs and plans
- Participate in audit/accreditation preparations, as needed.