Responsible for building provider credentials file and making file determinations regarding required credentialing criteria based on general guidelines, ensuring compliance with internal policies and external regulatory agencies.
MAJOR JOB DUTIES AND RESPONSIBILITIES:
- Receives provider applications and contacts providers for any additional supporting documentation or clarification.
- Builds file documentation and prepares file for credentialing committee review.
- Applies general guidelines in determining whether provider meets criteria and documents deficiencies. Prepares correspondence to providers regarding status.
- Assists in researching pended and probated applications and resolving discrepancies.
- Refers non-approved providers or questionable situations to senior representative.
- May assist in provider education and preparation of provider training materials.
- Performs other duties as assigned.
- Requires high school diploma or an equivalent combination of education and experience required.
- 3 years credentialing or related experience preferred.
Strong oral and written communication skills, research skills, ability to use word processing, spreadsheet and database software required.