Responsible for all aspects of credentialing/recredentialing of providers
Review and analyze credentialing documents, including education, residency and fellowship training, board certification and eligibility, licensure, professional work history, liability insurance, requests for clinical privileges and malpractice history.
Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
Completion of monthly monitoring.
Maintain consistent contact with healthcare providers to ensure that expectations are clear and requirements are completed in a timely manner.
Prepare materials and files necessary to comply with external audits by payors and/or governmental agencies.
Maintains ongoing communication with health plan representatives and contracted providers.
Any other special projects as requested by management
REQUIRED EXPERIENCE AND SKILLS:
Two plus years of experience in medical credentialing
Must be able to prioritize many tasks and exhibit excellent, mature judgment
Must be self-motivated and able to work independently with minimal supervision
Strong organization and administrative skills
Proficient in Microsoft Office, Word, Access and Excel
Working knowledge of CAQH.
Knowledge of NCQA, CMS and state rules regarding credentialing requirements.
Able to independently problem solve and research discrepancies and/or variances
Strong attention to detail
Excellent written and verbal communication skills
Internal Number: 1
About Strategic Healthcare Partners
Founded in 2007 by Principals John Crew and Mike Scribner, Strategic Healthcare Partners (SHP) is a healthcare services consulting firm that acts as an extension of our clients organization and tailors our services to meet their needs. SHP services include, but are not limited to: IPA management, Accountable Care Organizations management and consultation, deployment of Clinically Integrated Networks (CIN), Provider Enrollment, Managed Care contract negotiation and strategic planning, financial analysis, and revenue cycle analytics. We proudly serve and partner with over 35 hospitals, 900 physicians, 3 IPA’s, and 26 behavioral health centers via the state of Georgia Community Board Association.
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National Association Medical Staff Services | 2025 M Street NW, Suite 800, Washington, DC 20036
phone: 202-367-1196 | fax: 202-367-2196 | email:email@example.com