Job Description
Key Responsibilities:
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• Process and track initial payer credentialing, provider enrollment, recredentialing, and revalidation applications for participating providers.
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• Support behavioral health provider enrollment and credentialing, including collecting and reviewing payer-required documentation.
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• Prepare, assemble, review, and quality-check provider applications; follow up with providers and payers to resolve missing or inconsistent information.
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• Conduct credential verification and mandated queries as assigned, in accordance with policies and applicable payer requirements.
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• Enter, review, maintain, and update provider information in credentialing databases, CAQH, and payer systems.
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• Cleanse and validate credentialing/provider records to support the MD-Staff transition, identifying incomplete, outdated, or inconsistent data and coordinating corrections.
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• Monitor provider expirables, enrollment status, recredentialing deadlines, and payer revalidation cycles; maintain accurate documentation and status tracking.
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• Communicate with providers, practice managers, medical staff offices, and payer representatives to facilitate timely credentialing and enrollment.
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• Prepare reports and updates for downstream billing/system maintenance; support resolution of enrollment-related claim issues.
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• Protect confidential provider information and follow organizational privacy, compliance, and quality procedures.
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• Perform other related duties as assigned.