
Healthcare Provider Credentialing Coordinator
4 days ago
Credentialing and Privileging Expert
The successful candidate will have a strong understanding of credentialing and privileging processes, including payer enrollment requirements. They will be responsible for managing the end-to-end credentialing process for healthcare providers, including obtaining and verifying necessary documentation. This includes licenses, certifications, and education. Additionally, they will maintain accurate and up-to-date provider information in credentialing databases.
Main Accountabilities
- Credentialing Process Management:
- Manage the credentialing process for healthcare providers, ensuring compliance with industry standards and regulatory requirements.
- Maintain accurate provider records in credentialing databases.
- Ensure compliance with state, federal, and payer regulations.
- Monitor credentialing expirations and manage timely renewals of licenses, certifications, and insurance enrollments.
- Verify education, training, licensure, and work history through primary sources.
- Communicate with insurance companies, hospitals, and other healthcare organizations to ensure provider enrollments are completed.
- Maintain and update credentialing software and systems with accurate provider records.
- Generate regular reports on credentialing status and compliance metrics for management review.
- Work closely with providers, administrators, and third-party payers to resolve credentialing issues promptly.
- Assist in streamlining credentialing workflows to enhance efficiency.
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