Key Duties and Responsibilities :
- Review new applications and supporting documents in a virtual environment and apply policy and criteria required for credentialing processing
- Perform all required primary source verifications
- Contact hospitals, licensing agencies, malpractice carriers and medical schools to obtain credentialing verifications
- Maintain and update credentialing database records
- Review malpractice history. regulatory and disciplinary action reports issued by state and federal agencies invoking appropriate processes as defined in policies and procedures
- Review the CAQH system and download applications or supplemental documents as appropriate
- Maintain electronic provider files
- Perform outreach to providers and facilities via phone calls and fax/email correspondence
- Demonstrate knowledge of credentialing regulatory and accreditation requirements (NCQA. CMS. Medicaid. etc.)
Qualifications:
- 1+ year of healthcare experience HIGHLY PREFERRED
- 2+ years of experience in a customer service or healthcare related position required
- Must have skills with Internet browser and high volume data entry
- Production environment
- General PC skills
- Information gathering and researching
- Ability to work overtime