Responsibilities

• Provider File Management: Maintain and update provider files to ensure all information remains current for governmental and commercial payer credentialing applications.
• CAQH Database Maintenance: Regularly update each provider’s CAQH profile in compliance with CMS guidelines.
• License Management: Oversee applications and renewals for provider licenses, including Professional, DEA, and Controlled Substance licenses.
• Government Payer Revalidation: Complete revalidation requests to maintain provider enrollment with Medicare, Medicaid, and other government payers.
• Credentialing & Enrollment: Process credentialing applications to enroll providers in Medicare, Medicaid, and commercial payer networks.
• Re-Credentialing Compliance: Manage re-credentialing with commercial payers to ensure providers remain active in their networks.
• Hospital Credentialing: Facilitate credentialing and re-credentialing for providers at affiliated hospitals.
• Revenue Cycle Collaboration: Work closely with the Revenue Cycle Director and billing team to resolve credentialing-related denials or authorization issues.
• Database & Profile Management: Maintain accurate provider records across CAQH, PECOS, NPPES, and CMS databases.
• Internal Records & Access Management: Keep the internal provider grid updated, ensuring secure and accurate login credential management.
• Additional Duties: Perform other credentialing and administrative support tasks as assigned.