Credentialing Specialist

What You'll Do

Credentialing

• Exhibit wide-ranging experience and proficiency in performing all daily credentialing functions
• Review and conduct quality check of all daily functions, such as review of completed files, approval dates, license expiration dates, provider credentialing data
• Monitor provider status of credentialing files and communicate status updates to Credentialing Verification Organization (CVO)
• Manage data entry and accuracy for all necessary provider information such as NPI numbers and/or CAQH profile information to ensure accurate storage record of provider files
• Correspond with providers via Zendesk
• Coordinate with CVO and providers to ensure timely completion and maintenance of all credentialing correspondence and documentation in the Fountain system and implement Fountain system updates to reflect decisions in support of the Credentialing Manager

Recredentialing

• Ensure timely re-credentialing of the credentialed provider network by performing weekly follow-up review of provider CAQH status and communicating status to CVO when complete or the provider when incomplete
• Coordinate with CVO to ensure timely completion of re-credentialing review for each clinician
• Maintain CVO database and files management within Fountain to aid with the completion of recredentialing
• Performing quality assurance (QA) checks to ensure the uploaded documents in the Fountain system represent accurate data for each clinician
• Assist Credentialing Manager with outreach and retention in high need states for providers in jeopardy of failing to re-credential and remain in the TS network
• Assist Credentialing Manager as needed with completing duties related to the approved re-credentialed providers process
• Ensure accurate status for approved and re-credentialed providers in the Fountain system

Auditing

• Assist with quarterly internal audits to ensure efficiency and accuracy within the Credentialing Program using the audit tool
• Assist with annual external CVO audits to ensure compliance with the delegated credentialing agreement using the audit tool
• Work with Credentialing Manager and Enterprise clients to provide data for audits on an annual, monthly or ad hoc basis

Licensing

• Perform quality review of credentialed license data to ensure accuracy
• Initiate outreach of providers with expired license data to secure license renewal and retain providers in the state directory for the license in facilitating client transfer and/or deactivation with untimely license renewal

Relations Management

• Maintain relationship with Enterprise clients under the delegated credentialing agreement as support to the Credentialing Manager
• Performs other related duties as assigned.

About You

• 2-3 years of professional work experience in a highly communicative role.
• Bachelor's Degree preferred.
• Proficiency in Microsoft or like applications
• Proficiency with G-Suite or like applications
• Credentialing experience preferred.