CREDENTIALING ASSOCIATE

Job Description

Job Description

Essential Job Duties

• Complete provider initial and re-credentialing applications and submit with supporting documentation to all requested payers, hospitals, and ASCs
• Monitor application progress and follow up with payers until “in network” status has been confirmed/received
• Revalidation and recredentialing requests issued by government payers
• Maintain copies of providers’ required credentialing documents (current state licenses, DEA certificates, malpractice coverage, etc.)
• Track all state/medical licenses, DEA, and Board Certification/Recertification expirations; assist providers with renewals to ensure they are completed in a timely manner.
• Track CME and send quarterly updates to providers.
• Maintain Physician Extender (PE) Compliance and ensure that Audit Ready files remain up to date
• Renew MACM applications yearly, track expenses for providers and renew memberships/subscriptions
• Oversee malpractice claims and communicate with MACM, attorneys, and provider(s)
• Manage provider data via online databases and systems such as CAQH, PECOS, NPPES, etc.
• Responsible for PrimeSource Verification of State license, DEA, and Board Certification
• Assist physicians with ABOS WLA each year
• Manage Resident Rotations for BOS providers who participate in Memorial Hospital’s Family Medicine program
• Create, manage, and maintain emergency department on-call schedule for physicians using prior year’s call schedule as reference
• Primary liaison for call schedule changes between Bienville physicians, hospital staff, and Bienville’s answering service to ensure 24/7 coverage
• Assist with administrative assistant duties and other duties as assigned/needed

Additional Requirements:

• Excellent verbal and written communication skills
• Must demonstrate a high degree of trust and confidentiality
• Must get along well with others and have a team-oriented work ethic
• Ability to work independently and assume assigned responsibilities
• Ability to be flexible and function well in a fast-paced environment with multiple interruptions
• Must be able to travel to all clinic locations and work overtime as needed

Position is Full Time, Non-exempt, Hourly

Work Hours: Monday - Friday 8am-5pm (Occasional after hours support if needed)