-Process initial credentialing and re-credentialing applications for healthcare providers-Verify provider qualifications, including licenses, certifications, education, training, and work history-Ensure compliance with federal, state, and industry regulations (e.g., CMS, NCQA, Joint Commission, HIPAA)-Maintain accurate and up-to-date provider information in credentialing databases-Oversee the timelines and workflow processing of the reappointment cycles-Prioritize work to meet anticipated start dates and reappointment expiration-Accountable for the completeness and identifying issues requiring additional information or investigation on applications-Oversee the accuracy of application data entry and verification requests-Perform the final review of processed verifications for quality and content-Develop correspondence to obtain additional information as needed-Facilitate committees in preparation of agenda materials and follow-up of recommendations-Coordinate communication of final credentialing recommendations to all parties-Generate audits and reports to support/document the verifications and credentialing process
1-4 years
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-1???3 years of experience in provider credentialing, healthcare administration, or a related field preferred-Excellent customer service skills and ability to take initiative to meet the needs of all to ensure customer focus and a positive experience-Ability to communicate effectively and with a high level of diplomacy with providers-Must be able to work on multiple daily tasks with efficiency and high-quality accuracy while handling multiple internal and external customer communications-Responsible for planning work to meet regulatory and customer defined deadlines, which requires coordination to minimize redundancy of work when multiple organizations share common providers
High School
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