Credentialing Coordinator

Duties and Responsibilities

Essential Functions:

• Processes initial provider enrollment with payers, initial credentialing and recredentialing: • Creates, assembles and prepares application packet for providers to complete, reappointment applications for WellSpan Health entities and submits applications to payers. • Completes primary source verifying provider credentials per established policies and procedures. • Enters provider credentials and application requirements into Cactus, CAQH. • Initiates mandated queries, both federal and state, for all initial applicants and those due for recredentialing with the National Practitioner Data Bank. • Adheres to all policies and procedures regarding mandated queries and reporting mechanisms. • Maintains close communication with provider, practice managers, medical staff office, insurance reps, locum tenens agencies, office administrators to ensure timely credentialing through the different entities. • Reviews and conducts QA checks on the applications prior to medical director's review. • Reattests provider information every 120 days in CAQH. • Runs reports and complete Medicare and Medicaid revalidations for WellSpan Medical Group (WSMG) & Hospital Based providers. • Maintains confidentiality of provider information.
• Data Management • Follows up, receives and documents confirmations on all initial enrollment status and changes for health plan providers with which WellSpan participates. • Runs weekly Credentialing Update reports to IS Department for billing system update. • Runs expiring provider credentials reports, notifies practices and updates Cactus accordingly. • Assists with helping resolve claim issues by contacting applicable provider reps.
• Change letters • Creates and submits letters to update payers, Cactus, CAQH, NPI and other stakeholders of any changes and terms to provider data per 25 payer requirements.

Common Expectations:

• Maintains established policies and procedures, objectives, quality assessment and safety standards.
• Maintains professional growth and development.
• Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.