Job description
Credentialing all providers in the practice. This includes Medicare, Medicaid application, and Managed Care credentialing for all providers.
Credentialing facilities with insurance carriers.
Negotiating in-network contracts with insurance carriers for physicians and facilities.
Maintaining contracts.
Applying Hospital privileges for all providers in practice and working closely with the hospital credentialing department.
Meets with providers to gather, review, and provide guidance on the completion of complete credentialing packets. Also, coordinates the accurate input of physician information into CAQH, Medicare, Medicaid, and hospital databases.
Process of accurate complementation of Texas Standardized Credentialing Application in MS Word files for each physician.
Oversees input of physician documents into the database and proper maintenance of Medicare and Medicaid documents.
Continuously verify the status of CVs, provider licenses, DEA, DPS certificates, and specialty
certificates.
Continuously keep track on the renewal on provider licenses, DEA, DPS, ACLS certificates.
Maintain record keeping on providers’ CME and follow up with them to receive the CME they have provider’s
Ensure the provider’s information is forward to the appropriated channels on a routine basis.
Complete various provider applications and track the status of applications once submitted.
Maintain provider files for credentialing purposes.
Regularly updates Physician relevant information and sends to all payers.
Update appropriate departments of on the status of providers credentialing on Managed Care/Insurance.