What We Offer:

Credentialing Requirements Maintenance

• Ensure credentialing compliance standards are met per accrediting and regulatory agencies (i.e., CARF, JACHO, DHS, DBHDD).

• Prepare and submit state Medicare and Medicaid enrollments and re-validations.

• Thorough knowledge of CAQH, PECOS & NPPES, Availity applications.

• Knowledge of commonly used concepts, practices, and procedures used in health care credentialing.

• Prepare provider files for government and regulatory agency credentialing audits.

 

Application Maintenance

• Track and monitor incoming and outgoing credentialing requests, including maintenance of credentialing files.

• Audit files, obtain credentialing documents, or additional information as required.

• Track and follow up on all credentialing/recredentialing documentation as necessary.

• Contact providers to clarify discrepancies.

• Prepare and submit state Medicare, CMOs, and Medicaid enrollments and re-validations.

• Prepare and submit private insurance credentialing applications.

• Prepare and administer routine correspondence, memoranda, and notifications.

 

Special Projects

• Prepare APRN Protocol agreement and any supporting documentation.

• Offer Human Resources management in maintaining personnel records and preparing reports.

• Recommend improvements to enhance department or agency efficiency.

• Lead special projects with detailed action plans.

• Prepare and submit CLIA waiver application.