Position Summary
Manage, maintain and update files for all credentialing applications. Responsible for processing credentialing and recredentialing applications accurately and in a timely manner. Coordinate with medical office staff, licensing/regulatory agencies, and insurance carriers to ensure Quality Assurance compliance.
Schedule:
- Flexible, may require some evening and weekends
Primary Duties and Responsibilities
- Facilitate initial credentialing, on-going monitoring and re-credentialing process of all Providers in accordance with the National Committee for Quality Assurance standards.
- Maintain and update database for provider credentialing, including applications and all other related documents, such as California Medical license, DEA registration, NPI number, Medical School Diploma.
- Communicates with internal departments to assess addition and removal of providers onto NECC malpractice insurance; process renewal of malpractice insurance on a yearly basis.
- Complete California Participating Physician Application for all new providers and submit to IPA/Health Plans Credentialing Committee for approval; provide IPA/Health Plans with any additional Provider data, as requested.
- Serve as point of contact for IPAs; responsible for advising IPAs of all Provider changes and/or updates, including: demographic changes, clinic assignments, new Providers and release of existing Providers.
- Update IPAs of all Providers' renewed licenses (Medical licenses, DEA registration, etc.).
- Process Hospital Privileges Application for providers, as advised by Operations Director.
- Responsible for completing all Health Plan/IPA and questionnaires.
- Prepare and submit verification letters.
- Provide status reports as requested.
- Handle confidential information in an appropriate manner.
- Attend meetings and seminars, as necessary.
- Maintain a positive working relationship with staff.
- Serves as the Licensing/Certifications Department back up.
- Other duties as designated by Operations Director or Executive Director