What are the responsibilities and job description for the Credentialing Specialist position at Nephrology Associates of?
Description:
NANI is seeking a Credentialing Specialist. This position will be responsible for all aspects of the credentialing, re-credentialing and privileging processes for all medical providers who provide patient care for NANI. This role will be responsible for ensuring providers are credentialed, appointed, and privileged with health plans, hospitals, Medicare, Medicaid and patient care facilities. The Credentialing Specialist will need to maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications. It will be necessary to maintain and update all Insurance Credentialing requirements and assist in the licensure application process for licensed professionals.
Responsibilities
- Compiles and maintains current and accurate data for all providers
- Completes provider payer enrollment applications; monitors applications and follows-up as needed
- Maintains copies of current state licenses, DEA certifications, malpractice coverage and any other required credentialing documents for all providers
- Maintains knowledge of current health plan and agency requirements for credentialing providers
- Sets up and maintains provider information in credentialing databases and systems
- Tracks license and certification expirations for all providers to ensure timely renewals
- Ensures practice addresses are current with health plans, agencies, and other entities
- Tracks license, DEA and professional liability expirations for providers
- Audits health plan directories for current and accurate provider information
- Maintains confidentiality of provider information
- Provides credentialing and privileging verifications
Health plan/Hospital credentialing is required
