Essential Job Functions
• Data collection and management
• Collects provider credentials and updates internal/external databases
• Streamlines onboarding process/workflow for individual providers, practice locations, and physician groups
• Interacts with varied levels of management, office staff, and physicians effectively to complete various elements of enrollment/credentialing
• Maintain confidentiality of personal provider information
• Keep provider data up to date in databases
• Ensures requisite licenses, malpractice coverage, and certifications are all current for all providers/groups
• Submit credentialing applications and supporting documentation in a timely manner to cover all dates of service for providers
• Maintain provider/group demographic info and rosters including terminations, add-on, etc.
• Individual revalidations with various insurance payors
• Coordinate and prepare reports in a timely matter; weekly and monthly
• Provide aggressive follow up with insurance payors regarding credentialing status
• Maintain deficiency reports for all credentialing applications, developments, and issues
• Maintain CAQH accounts for providers, including supporting documentation
• Address AR billing claim issues related to provider enrollments
• Supervision of start-up projects and expansions
• Other RCM initiatives that support the Omega scope of client services
• Perform duties in compliance with Company’s policies and procedures, including but not limited to those related to HIPAA and compliance.
5 years of experience in provider enrollment/credentialing within a multi-location physician practice management company, RCM, or healthcare system.