Qualification – Graduate
Job Description :
- Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications
- Maintain internal provider grid to ensure all information is accurate and logins are available
- Update each providers CAQH database file timely according to the schedule published by CMS
- Apply for and renew annually all provider licenses; Professional, DEA, Controlled Substance
- Complete revalidation requests issued by government payers
- Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid
- Complete re-credentialing applications for commercial payers
- Credential new providers and re-credential current providers with hospitals at which they hold staff privileges
- Work closely with the Revenue Cycle Director and billing staff to identify and resolve any denials or authorization issues related to provider credentialing
- Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases
Other duties as assigned