Job Description

• Provides 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.
• Maintains accurate and current information in the provider records in credentialing software database and in provider electronic folders.
• Maintains credential files in an orderly and current manner.
• Provides research and administrative support for special projects.
• Ensures 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.