Reports to Practice Manager and under the direction of Practice Financial and Administrative Service Coordinator provides all aspects of the credentialing and privileging processes for all medical providers who provide patient care at Anchor Medical Associates. Responsible for ensuring providers are credentialed appointed and privileged with health plans and hospitals. Maintain up-to-date data for each provider in credentialing databases and online systems.

Compiles and maintains current and accurate data for all providers.

Completes provider credentialing and recredentialing applications.

Monitors and tracks initial and reapplications sent received and processing time.

Acts on non-returned new and (re)applications and conducts follow-up of initial and (re)applications in accordance with policies and procedures.

Reviews initial (re)applications for clarity quality and completeness of data in accordance with policies and procedures.

Performs timely and accurate scanning data entry/entry validation of application information received in the database.

Keeps new providers practice managers and billing staff informed of the status of credentialing process

Serving as a liaison with other internal/external customers as it relates to participating provider network or other credentialing related issues and concerns.

Maintains knowledge of current health plan hospital and agency requirements for credentialing primary care and behavioral health providers.

Maintains participating provider health plan contract files.

Maintains health plan directories for current and accurate provider information.

Maintains provider revalidations verifications and attestations in accordance with health plan requirements.

Tracks licenses certifications and continuing education credits for all providers to ensure timely renewal; updates provider renewal information in online credentialing databases and system.

Performs other duties as assigned.

Data Management Responsibilities

Maintains an electronic record/file for all providers within the central admin folder on the shared drive or credentialing database giving attention to operational concerns and the need for others to retrieve the same records.

Maintains integrity shared drive and credentialing database which includes the entering/importing of practitioner information in accordance with departmental policies and procedures.

Utilizes appropriate database tracking reports to ensure accuracy and thoroughness of data entry documentation.

Documents interactions with internal and external customers as appropriate within the appropriate fields of the credentialing database.

Aids in the development and revision of the credentialing and audit workflows within the credentialing database.

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Maintains confidentiality of provider information in accordance with practice policies and procedures.

EDUCATION:

High school diploma or equivalent. Associate�s or bachelor�s degree in a related field preferred.

CPCS Certification preferred.

EXPERIENCE and SKILLS:

Three years of relevant credentialing experience

Experience in general office practices and software applications and database management.

Knowledge and understanding of the credentialing process

Ability to organize and prioritize work while ensuring deadlines are met.

Excellent verbal and written communication skills including letters memos and emails.

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Excellent attention to detail.

Ability to establish and maintain effective working relationships with providers management staff and contacts outside the organization.

Ability to work independently with minimal direction or supervision.

Proficient use of Microsoft Office applications (Word Excel Access Outlook)

Knowledge of web based systems including but not limited to CAQH PECOS NPPES and Optum.

SUPERVISORY RESPONSIBILITY:

None