Job Description

Job Responsibilities:

• Responsible for the timely and accurate processing of all providers including NP’s/PA’s/MD’s initial and Re-credentialing applications according to the Minute Clinic Provider Credentialing Program
• Monitor Expired licensure reporting, data base tasks and maintain system updates and weekly reporting to leadership
• Manage Epic access for any providers that have out of compliance licensure and/or board certification.
• Conduct sanctions and compliance monitoring and alert Credentialing Manager and Revenue Director of any undisclosed negative findings
• Process malpractice insurance verification requests according to internal policies
• Maintain the provider and physician SharePoint sites and Communicate provider statuses with leadership and other internal teams to meet timelines
• Submit system access requests upon credentialing approvals/clinic eligibility
• Support the payer enrollment team as needed to resolve any payer claim issues
• Monitor Provider and Clinic change/Termination reports and update database accordingly
• Process Name changes according to Minute Clinic policies and procedures
• Daily maintenance of provider credentialing grids with notification to appropriate teams
• Review and distribute all incoming mail as needed
• Support Payer Audits in accordance with Minute Clinic, Joint Commission and NCQA requirements
• Maintain provider files with the most current information/documentation
• Notify system analyst and leadership of any system and state agencies interruptions/updates/password changes
• Make recommendations for process improvement and system efficiencies
• Attend and engage in all team meetings
• Model a positive attitude in interactions with team members

Skills:

• Demonstrated understanding of initial credentialing and re-credentialing practices for medical professionals including primary source verification methods, compliance monitoring and expirable management.
• Proficient in quantitative analysis
• Understanding of Joint Commission Accreditation, NCQA and URAC credentialing standards.
• Competent user of Microsoft Office, Outlook, Word, and Excel
• A minimum of 3 years’ experience in the healthcare industry with experience in credentialing

Education/Experience:

• Verifiable High School Diploma is required.
• Associate/ Bachelor will work

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