Primary duties may include, but are not limited to:

Supports all Field Representatives to obtain agreements, Credentialing and Health Plan request documentation

Reviews and processes incoming and outgoing required paperwork, including provider credentialing applications, Welcome letters, and all other related forms, according to the Department’s Policies and Procedures.

Receives provider applications and contacts providers for any additional supporting documentation or clarification.

Builds file documentation and prepares file for credentialing committee review.

Ensures credentialing information is communicated timely to all internal departments responsible for loading systems that support claims processing

Responsible for maintaining physician credentialing database and ensuring integrity of data maintained.

Strong organizational skills, including time management and ability to manage high-volume email correspondence

Answers incoming telephone inquiries from providers and assists with the resolution of Contracting/Credentialing issues/needs.

Audits credentialing packets and tracks new credentialing and re-credentialing applications

Conduct ongoing licensure/Medicaid sanctions/Medicare Opt Out monitoring.

Manage provider directory

Effectively manage follow up calls and email

Respond to provider inquiries, concerns or complaints related to the onboarding process

Maintain both electronic and hard copies of provider agreements, registrations and or applications

Other duties as may be assigned

Leon Health, Inc. jobs

Credentialing and Provider Relations Specialist