The Credentialing Assistant will provide support to the credentialing function in recording, maintaining, and reporting of credentialing data and will also coordinate MCO processes

Responsibilities

• Coordinate credentialing with all Commercials & MCO Insurances
• Review all rosters from insurance companies and ensure they match the center’s rosters
• Updating and maintaining JPA Credentialing Roster for Commercials & MCO enrollments
• Maintain and/or Create CAQH profile for all medical providers
• Follow up and coordinate enrollment of providers with CAQH
• Work closely with managed care representatives to obtain updates on providers’ status
• Coordinate the re-credentialing of all providers every two years
• Coordinate termination of providers with managed care
• Assist with presentation of providers at QA meetings for review and approval by CMO
• Assist in the delegation process with managed care every two to three years.
• Maintains and updates credentialing and managed care files
• Maintains Data on Roster with updated providers’ information
• Work with Medical Director on physicians Change of Status (i.e, shift changes, locations changes, terminated and new hires)
• Work closely with Billing and Front Desk regarding to resolve issues regarding providers’ participation with managed care companies
• Assist in maintaining and update Nurses, Social Workers, Lab data roster with current: License, Infection Control, BLS, PALS, ACLS certifications
• Assist in coordinating Managed Care Contract review
• Ability to travel across all sites
  
  

This job specification should not be construed to imply that these requirements are the exclusive standards of the position. Incumbents will follow any other instructions and perform any other related duties, as may be required by their Supervisor.

Minimum Qualifications

• HS Diploma or Associate degree ( preferred)
• At least 1 year of related experience.
• Proficient computer skills using MS Office, particularly Excel Spreadsheet.
• Reliable transportation to travel to all sites.
• Attention to details and good interpersonal skills.
  
  

This is a 100% in office position.