Daily tasks and responsibilities include, but not limited to:
- Provide support and assistance for new practice setup as needed.
- Assist with the completing and submitting provider enrollment applications.
- Track progress of outstanding applications and communicate with provider relations representatives for follow-up ensuring enrollment completion.
- Maintain accurate and current information in the provider records in credentialing software database and in provider electronic folders.
- Maintain credential files in an orderly and current manner.
- Provide research and administrative support for special projects.
- Ensure HIPAA guidelines are respected by safeguarding protected health information in the capacity of the position and responsibilities.
- Create new credentials electronic files, save provider’s credentials to that file according to Global Share Filing Structure Policy, create new Practice and Provider Data Sheets.
- Provider Credentials: Maintain current credentials i.e. medical licensure, DEA, COI’s, etc. and set Verity CredentialStream reminders for notification of future expiration dates; maintain Provider Data Sheets with current credentialing information; maintain the credentials spreadsheet for the emergency and urgent care practices.
- CAQH Re-attestation: Maintain CAQH re-attestation spreadsheet and re-attest as required updating any expired credentials.
- Incoming E-mail, Faxes: Respond to requests for renewed credentials, W-9s, etc.
- Maintain Electronic Files: Update provider files with current information, documentation.
- Credentialing Software: Document all daily activities in Verity CredentalStream and Teamwork.
- Change of Information: Submit to health plans change of information letters and W-9s regarding practice moves, adding locations, changing remit addresses.
- Follow-up: Make calls or send emails to health plans and/or medical facilities to check status of applications, change of information letters, or contracts.
Important Note: This Job Description is subject to any reasonable adjustment in accordance with the changing and developing needs of the position.
Qualifications and Requirements
- Preferably College Graduate or at least 2 years in College
- Degrees and Courses related to Medical Field is a plus
- Strong written and verbal communication skills
- Ability to work effectively with minimal supervision
- Ability to work with confidential information
- Detail oriented
- Proficient in the use of email
- Highly motivated self-starter
- Organized, able to set priorities and meet deadlines
- Dependable and reliable
- Team player being supportive of Department and Company goals and policies
- Must be flexible with schedule
- Previous call center experience related to Medical Accounts and Programs is a plus