GENERAL SUMMARY:

Facilitates and processes provider credentialing files in a timely and accurate manner.

PRINCIPAL JOB FUNCTIONS:

1. *Commits to the mission, vision, beliefs and consistently demonstrates our core values.

2. * Facilitates distribution of provider credentialing packets for appointment and reappointment.

3. *Provides practitioners with appropriate delineation of privilege forms.

4. *Completes primary source verification on practitioner applications.

5. *Ensures that all practitioner credentialing files are completed and submitted to the appropriate facility within 30 business days of receipt of the completed application and supporting documents.

6. *Completes follow-up on delinquent credentialing file items (i.e. application information, hospital affiliations and peer references).

7. *Provides appropriate and timely responses to any inquiries from facilities or provider/provider offices.

8. *Identifies and notates the provider file with any potential red flag findings in the verification process.

9. *Proactively requests upcoming expirable items (i.e. State License, DEA License and Malpractice Insurances).

10. *Maintains information on sanctions and insurance liability claims.

11. *Provides quality assurance audit for each provider file prior to distribution of completed file.

12. *Utilizes relevant software to produce communication; sets up databases and tracks regulation compliance.

13. Facilitates solving of software and technology issues as they arise to ensure efficient functioning of programs.

14. Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise.

15. Participates in meetings, committees and department projects as assigned.

16. Performs other related projects and duties as assigned.

EDUCATION AND EXPERIENCE:

High School Degree required. Associate’s degree preferred. Minimum of two (2) years experience in a medical office or administrative support position required. Prior experience in credentialing preferred.