Job Description

This position is responsible for the initial credentialing and re-credentialing of network providers, and for the maintenance of provider credentialing files, electronically and on paper. Complies with the HS1 Credentialing Program Description which meets URAC and AHCA requirements.

Essential Functions & Responsibilities

• Receive and process all credentialing/re-credentialing applications according to Company policies and procedure. Maintain accurate and complete records as to the status of each application.
• Data Entry of provider information into the computer system.
• Prepare new provider applications and re-credentialing applications for the Credentialing Committee to review.
• Attends Monthly Credentialing Committee meetings as needed and assist in preparation for meeting.
• Maintain initial and re-credentialing established timelines.
• Communicate with providers to update expired credentials, clarify information and other credentialing related issues for initial and re-credentialing.
• Maintain a strict level of confidentiality for all matters pertaining to provider credentials.

Required Education and Experience

High school diploma or general education degree (GED) College experience preferred. Two years or more of managed care credentialing experience.