Summary of Job
Responsible for preparing provider enrollment applications, demographic updates and tracking metrics for all eligible provider types. Ensure enrollment activities meets federal, state and department guidelines when processing application submissions. Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications. Reports to Director of Credentialing and CVO.
Essential Duties and Responsibilities
• Compiles and maintains current and accurate data for all providers.
• Completes provider enrollment credentialing and re-credentialing applications; monitors applications and follows-up as needed.
• Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
• Build knowledge base for payer requirements and forms for multiple states.
• Track license and certification expirations for all providers to ensure timely renewals.
• Prepare meeting agendas and minutes for client calls.
• Train credentialing specialist (if applicable).
• Audit work completed by other departments (delegation/CAQH/Data Entry/Group & provider set up).
• Provide monthly invoicing data.
• Generate and send sign pages/application to client.
• Report to management any detected problems, errors, and/or changes in provider enrollment requirements upon discovery.