Position Information: Responsible for all aspects pertaining to credentialing and re-credentialing providers in order to participate in provider service contracts. Essential Duties:
Responsible for initiating and processing provider applications for the purpose of credentialing them as a provider under contract or when provider contracts are signed.
Responsible for processing re-credentialing applications by appropriate deadlines.
Gains an understanding of the credentialing processes used by each provider services contract and assists to expedite the processes when possible.
Establishes and maintains effective lines of communication with each provider services contract.
Maintains current files for all physician providers. Maintains a central database showing the current credentialing status for each provider under services contracts.
Provides current information to physicians concerning their credentialing status. Responsible for providing credentialing information to the billing office in the submission and resubmissions of claims.
Retrieves inquiries from the National Practitioner Data Bank and information from the IDX information system.
Performs various duties as needed to successfully fulfill the function of the position.
Education: Associate's degree in Business, Information Systems, Health Administration or related field Experience: 12 months experience in credentialing healthcare providers Equivalency Substitution: Will accept 24 months credentialing healthcare providers in lieu of the Associate's degree for a total of 36 months of experience Knowledge, Skills & Abilities:
Working knowledge of credentialing providers' process
Knowledge of IDX system
Working knowledge of the National Practitioner Data Bank
Ability to multitask and meet deadlines in a timely manner
Proficient with Microsoft Office Suite (Word, Outlook, and Excel)