Job Description

Job Description

Job Description

Key Responsibilities:

• Verification and Documentation:
• Collect, review, and verify the credentials of healthcare professionals, including licenses, certifications, and educational transcripts.
• Ensure the accuracy and completeness of provider applications and supporting documents.
• Maintain comprehensive and accurate records of provider credentials, ensuring compliance with regulatory and organizational standards.
• Conduct primary source verification to confirm the accuracy of information provided by healthcare professionals.
• Compliance and Regulations:
• Stay up-to-date on current credentialing regulations, policies, and standards.
• Ensure compliance with federal, state, and local regulations related to healthcare provider credentialing.
• Maintain confidentiality of provider information, adhering to HIPAA guidelines.
• Database Management:
• Enter, update, and maintain data from provider applications into credentialing databases.
• Monitor and track credential expiration dates and ensure timely renewals.
• Manage and maintain provider profiles in various health insurance portals and databases.
• Communication and Collaboration:
• Communicate with healthcare providers, insurance companies, and other stakeholders regarding credentialing matters.
• Answer questions from providers, customers, and staff regarding the credentialing process.
• Collaborate with other departments, such as human resources and medical staff services, to ensure smooth credentialing processes.
• Other Duties:
• Assist with the recredentialing process, ensuring that healthcare professionals meet ongoing requirements.
• May be involved in developing and implementing credentialing policies and procedures.
• May assist with the onboarding of new healthcare providers.
• May be responsible for tracking CME (Continuing Medical Education) requirements.

E04JI802opkq407euou

Job Tags

Similar Jobs