Coordinate, monitor, and maintain the credentialing and re- credentialing of provider applicants.
Facilitate all aspects of appointment, reappointment, and privileging maintenance for managed care, medical staff, and non-physician providers.
Assist in compliance with the contracted managed care payers, accrediting and regulatory agencies (i.e., NCQA, Joint Commission, URAC), in regards to credentialing while developing and maintaining a working knowledge of the organizational guidelines, statutes and laws.
Collect relevant and critical data to determine applicant's eligibility to be credentialed.
Evaluate and review applications for accuracy and completeness.
Gather and conduct primary source verifications of confidential healthcare provider credentials.
Contact and follow up with applicant, primary source organizations department and contracted Medical Staff Offices to obtain docum...