Credentialing Specialist - Morristown, United States - Talent Software Services

Talent Software Services Morristown, United States

3 weeks ago

Description

Job Function 1:

Maintains physician credentials necessary to ensure initial and continued enrollment into participating insurance plans.

Job Function 2:

Follows up on credentialing applications per established follow up time frames. Alerts Credentialing Coordinator of any concerns. Tracks applications and correspondence with insurance plans through to final completion.

Job Function 3:

Provides routine reports to physicians and support staff regarding the status of participation in insurance plans.

Job Function 4:

Updates and maintains the ECHO and CAQH databases.

Job Function 5:

Ongoing communication between Client's Health System divisions and billing company to ensure physician participation remains active

Job Function 6:

Provides updates to the Credentialing Manager regarding managed care plan credentialing procedure changes and other relevant information.

Job Function 7:

Establishes a rapport with managed care plan reps to enhance Client's Health System standing.

Job Function 8:

Intake credentialing packet. Prepare document checklist and cover page. Alert Credentialing Manager of any concerns (not board certified, no hospital privileges etc.).

Establish a rapport with the practice coordinator/manager to gather missing items in order to ensure applications are released on time.

Job Function 9:

Maintain Provider Database. Add new providers when approved to release credentialing applications. Move providers who are no longer affiliated with Client's Medical Group to the second tab on spreadsheet.

Job Function 10:

Undertakes special projects and assignments as directed by the manager.

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