Develops procedures for credentialing per the credentialing requirements for the center.

Requests and files applications, credentialing documents, and supporting material.

Receives applications for credentials, reviews references, and verifies each staff applicant’s qualifications, competency, and scope of practice credentials in their file.

Conducts or assists with the investigation and appropriate reporting of adverse or incomplete information.

Coordinates credentialing correspondence.

Maintains confidentiality of information processed.

Monitors and evaluates the center’s relevant employment and credentialing policies and procedures and makes suggestions for improvements, as needed.

Maintains professional courtesy at all times.

Completes organizational and provider credentialing and re-credentialing applications; monitors applications and follows up as needed.

Maintains knowledge of current health plan and agency requirements for credentialing providers.

Set up and maintain organizational and provider information in online credentialing databases and systems.

Ensures practice addresses are current with health plans, agencies and other entities.

Maintain organizational and individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications.

Maintain the internal provider grid to ensure all information is accurate and logins are available.

Update each provider’s CAQH database file in a timely according to the schedule published by CMS.

Complete revalidation requests issued by government payers.

Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid.

Complete re-credentialing applications for commercial payers.

Work closely with the Billing Office Coordinator and billing staff to identify and resolve any denials or authorization issues related to provider credentialing.

Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases.

Demonstrating flexibility, enthusiasm, and willingness to cooperate while working with others in assigned inter-professional care teams to support PCMH programmatic activities.

Participate in population management activities as directed.

Assist the care team by measuring quality, identifying, refining, and implementing practice improvements that support the medical home, and assisting in performance evaluation and quality improvement.

Apply the principles of comprehensive, community-based, patient-centered, developmentally appropriate, and culturally and linguistically sensitive care.

Attends CQI and Board of Director meetings regarding present credentialing.

Assist the HR Department in employee engagement activities, events, or tasks.

Assist the HR Department in maintaining records and filings.

Develop and communicate positive employee relations strategies and retention initiatives that foster and promote a culture of excellence.

Assist with and maintain measurement standards to provide meaningful information to guide continual improvement and increase employee engagement, satisfaction, and retention.

Responsible for ensuring content consistency of messages and alignment to overall company and HR strategy.

Performs all other related duties as assigned.