DUTIES AND RESPONSIBILITIES:

• Complete all applications in accordance with government and payor standards and submit applications within the required reporting period.
• Gather and obtain all appropriate documentation for facilities and physicians’ payor enrollment.
• Perform necessary follow-up with each Contractor and respond to all inquiries or requests with the allotted timeframe.
• Communicate effectively with the facility Managers, Payors, and Physicians.
• Research facility or physician enrollment and credentialing related issues.
• Work with the staff to adhere to new policies as well as communicate necessary changes as impacted by regulations (CME’s, Licensures, etc.).
• Oversee credentialing process by notifying Credentialing Verification Organization (CVO) and Payors of new and terminated providers and of any changes.
• Complete Payor facility credentialing applications.
• Maintain accurate credentialing files for physicians, physician assistants and all allied health professionals, i.e. licenses, DEA, CV, Malpractice Certificates, Business Licenses, and liability certificates.
• Review and enter physician logs into database.
• Serve as liaison between Credentialing Department and all other facilities to assist with education of and compliance with Medical Staff Bylaws.
• Assist in performing internal compliance investigations and audits throughout the organization, including compiling detailed reports with recommendations to the Compliance Officer and management.
• Assist in performing ongoing compliance training throughout the organization.
• Provide ongoing advice and resources to management for compliance issues and process monitoring and improvement, and work with management to implement these improvements.
• Assist with contract negotiations and special projects as needed.

KNOWLEDGE:

• Knowledge of credentialing policies and procedures.
• Knowledge of government application filing.
• Knowledge of record-keeping practices.
• Knowledge of customer service principles and techniques.

SKILLS:

• Skill in using word processing, spreadsheet and database management.
• Skill in communicating clearly and concisely.
• Skill in handling confidential information.
• Ability to analyze, extract and interpret government enrollment and billing regulations.
• Skill in understanding of practice compliance regulations.

ABILITIES:

• Ability to work effectively with all levels of personnel including physicians, managers and other staff.
• Ability to be highly efficient, organized and accurate in work.
• Ability to plan, prioritize, and complete tasks.
• Ability to handle sensitive and confidential information.