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Credentialing Representative

  • Location

    Hooksett, United States

  • Sector:

    Other Area(s)

  • Job type:

    Contract

  • Contact:

    Leric Arcigal

  • Job ref:

    22441

  • Published:

    4 months ago

  • Expiry date:

    2020-12-10

This position is responsible for working within implemented procedures related to credentialing and re-credentialing of medical and behavioral facilities. Must be able to accurately and efficiently process initial credentialing and re-credentialing application as well as follow specific guidelines listed in CR-04 and job aids.

Reviews and process initial credentialing and re-credentialing application for Medical and Behavioral Line of Business.

Manage/Oversees centralized verification of current licensure and certification for Medical and Behavioral facilities and Ancillaries.

Conduct thorough review of obtained credentialing information to ensure compliance with policy and regulatory requirements.

Establish and maintain constant communication with Contracting or other matrix partners to ensure facilities updated information have been acquired and make necessary adjustments as needed.

Serve as a Subject Matter Expert and act as a resource for management and matrix partners.

Obtain Primary Source Verification via secure website.

Ensure timely follow-up and processing to meet agreed upon standards.

Consistently achieves 100 % accuracy on all systems data entry.

Manages assigned mailboxes and responds to inquiry accurately and within the department standards.

Run credentialing committee and bariatric reports timely and accurately.

Complete projects as assigned.