Credentialing Specialist

 

Summary of Job

 

Responsible for preparing provider enrollment applications, demographic updates and tracking metrics for all eligible provider types. Ensure enrollment activities meets federal, state and department guidelines when processing application submissions. Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications. Reports to Director of Credentialing and CVO.

 

 

Essential Duties and Responsibilities

 

• Provides support Credentialing Account Manager.

• Compiles and maintains current and accurate data for all providers.

• Completes provider enrollment credentialing and re-credentialing applications; monitors applications and follows-up as needed.

• Build knowledge base for payer requirements and forms.

• Assist with filing, scanning and mailing as needed.

• Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.

• Prepare and send provider demographic updates.

• Track license and certification expirations for all providers to ensure timely renewals.

• Generate and send sign pages/application to client.

• Additional projects as assigned.