JOB SUMMARY

Independently performs tasks that require knowledge and implementation of policies, procedures, and general methods of operation. Responsible for collecting information based on facts, conducting research and analysis and making recommendations that will be used by others to a higher hierarchical level. Evaluates complex situations that require application and knowledge of policies, methods, and procedures for recruitment. The use of the trial is focused on collecting, organizing, and presenting information relevant to a situation or problem, channeling the supervisor those unusual situations, or not covered by procedures. Collaborate and participate in functions related to the procurement process, credentialization and in the development of strategies to maintain the adequacy of the network.

ESSENTIAL FUNCTIONS

• Reviews Provider’s application and ensures that it has been appropriately completed with all required documentation according to the provider specialty, provider type and or contracted services as required by the federal regulatory (CMS), local government requirements (ASES), URAC Accreditation and company’s policies and procedures as part of the credentialing and re credentialing processes. 
• Coordinates obtaining information from internal and external (Primary and Secondary Sources) sources to ensure receipt of the necessary documents to complete the Credentialing process and, or Re-credentialing process documentation. 
• Updates Credentialing and Re-credentialing information and documentation in the credentialing software’s and, or tracking tools.
• Contact the Provider’s as needed (via email and, or phone) to ensure receipt the documents to complete the credentialing process or re credentialing.
  Prepares reports related to the credentialing and re credentialing process activities for supports tracking and maintenance of metrics for the department.
• Prepares and audits the file containing the documentation in accordance with criteria established by the regulatory agencies and company’s policies and procedures for review and determination by the Credentialing Committee.
• Manages confidential Provider’s information according to policies, procedures, and applicable regulations.
• Daily acts as the primary point of contact and liaison for all internal and external customers on issues, concerns, questions, or situations of the credentialing process.
• Participates in projects and assists in the implementation of systems and procedures to ensure that all credentials and accreditation processes are performed according to the regulations, policies, and standards.
• Performs other task related as assigned by the supervisor and that are essential to the corporation's objectives and division operational plans.

EDUCATION

EXPERIENCE

Associate degree (AD) or at least 60-64 college credits, with one (1) to three (3) years of related experience.

LICENSES AND CERTIFICATIONS

COMPETENCIES