Credentialing Specialist

Essential Job Functions

• Completes all applications using primary source verifications.
• Identify any adverse actions from provider and document for review.
• Review completed applications for submission to Credentialing Committee for approval.
• Ensures that all provider files are complete with current licensing and certification documents.
• When appropriate, works cooperatively with administrative staff to obtain pertinent information necessary for IPA's.
• Possess thorough understanding of credentialing terminology and documents and is able to utilize external systems used to research and obtain pertinent information.
• Manages provider profiles in practice management system.
• Manages IPA coordination for information, and ensures providers are maximized.
• Responsible for the timely gathering and submitting for processing to IPA’s and health plans on an ongoing basis, all credentialing and re-appointment applications.
• Affords assistance to provider on completing credentialing application when necessary.
• Tracks all pending applications and notifies the Manager of any challenges with obtaining provider information.
• Responsible for reviewing and verifying all credentialing documentation for providers, confirming consistency and accuracy based on regulatory requirements.
• Captures review and approval of clean files by the Medical Director.
• Prepares credentialing documentation for the Risk Management and Compliance Committee.
• Prepares credentialing documents for approval from the Medical Director and Credentialing Committee.
• Affords assistance to Manager with credentialing audits.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.
• Coordinates review and approval of clean files by the Medical Director.