Job Description

Credentialing Specialist

Job Description:

The Credentialing Specialist will be responsible for leading, coordinating, monitoring, and maintaining the credentialing and re-credentialing process.

• Liaise between the practitioners, health plans, hospitals, patient care facilities, and all related entities regarding credentialing, malpractice coverage, and practitioner enrollment.
• Manage credentialing and re-credentialing processes along with completing applications for respective Commercial, Medicaid, and Medicare healthcare plans; contacting doctors for additional documentation if required; monitoring applications for timely approval and follow-up as needed.
• Management of CAQH applications including completion and updates. Maintains provider information in online credentialing databases and systems.
• Responsible for all necessary updates including, but not limited to address changes, NPI updates, etc.
• Ensures facility addresses and provider information are current with health plans, agencies, and other entities.
• Coordinate, compile, and prepare reports pertaining to doctors as requested. Preparation of correspondence associated with the credentialing process.
• Maintains knowledge of current health plans and agencies' requirements for credentialing doctors.
• Tracks license and certification expirations for all practitioners to ensure timely renewals. Follow-up with practitioners regarding expiring documents to ensure compliance.
• Performs other duties as assigned.

Company Description:

To provide personalized, comprehensive care by integrating traditional wisdom with modern medical practices, ensuring each patient receives tailored treatments that address their unique physical, mental, and spiritual needs.

Address:
Priority Family Care Center

2423 N. Broadway
LA CA 90031

Industry:  Healthcare.

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