Responsible for all aspects of the credentialing, re-credentialing and privileging for all medical providers who provide patient care at Family Physicians Group. Responsible for ensuring providers are credentialed, appointed and privileged with health plans, hospitals, and patient care facilities. Maintain up-to-date data for each provider in databases and online systems; ensure timely renewal of licenses and certifications.Essential Functions and Duties
- Establish, retain and grow strong relationships with providers.
- Compiles and maintains current and accurate data for all providers.
- Completes provider credentialing and re-credentialing applications; monitors applications and follow-up as needed.
- Maintains copies of current state licenses, provider list of OIG, DEA certifications, malpractice coverage and any other required credentialing documents for all providers.
- Maintains corporate provider applications files.
- Maintains knowledge of current health plan and agency requirements for credentialing providers.
- Sets up and maintain providers’ information in online credentialing databases and system.
- Tracks license and certification expirations for all providers to ensure timely renewals.
- Track building, elevators, septic systems licenses and renewals.
- Ensure practice addresses are current with health plans, agencies and other entities.
- Processes applications for appointment and reappointment of privileges FPG.
- Tracks license, DEA and professional liability expirations for appointed ASC providers.
- Maintains ASC appointment files, and information in credentialing database.
- Audits health plan directories for current and accurate provider information.
- Maintains confidentiality of provider information.
- Provides credentialing and privileging verifications
- Performs other duties as assigned.
- Three to Five (3-5) years’ experience in credentialing
- Must have experience in Cactus
- Bilingual prefer (English/ Spanish)
- Certified Provider Credentialing Specialist (CPCS) preferred.
- Knowledge of and understanding of the credentialing process.
- Able to organize and prioritize work and manage multiple priorities.
- Able to be collaborative and effectively communicate with providers.
- Able to have strong sense of urgency and use judgment to respond to emergencies.
- Able to solve practical problems and deal with a variety of situations.
- Excellent attention to detail.
- Excellent verbal and written communication skills including, letters, memos, and emails.
- Proficient use of Microsoft Office Applications (Word, Excel, Access) and internet resources.
- Medical Credentialing: 3 years (Required)
- CPCS preferred
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