Credentialist II - Provider Enrollment

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Under the direction of the System Director, Professional Provider Administration, the Credentialist II - Provider Enrollment carries out all phases of Provider Enrollment credentialing functions.

Job Duties and Responsibilities:
1. Performs all phases of credentialing functions related to initial appointments and reappointments forMedicare, Medicaid, and contracted Managed Care organizations. Assures timely, accurate, andcomplete credentialing in accordance with the Medical Staff Bylaws, the Credentialing Plan andpolicies and procedures of Medical Staff and the Corporation. Maintains and assures accuracy withinthe credentialing software database, electronic credentialing files, and paper credentials files.

2. Maintains professional relationships with the Medical Staff, department directors, departmentmanagers, managed care staff, administrative staff and representatives of managed careorganizations. Prepares, sends, and tracks correspondence for verification, reappointments, andother routine items that support the Provider Enrollment credentialing functions, and other duties
essential to the smooth functioning of the Medical Staff Services department.

3. Performs all phases of professional billing credentialing for all new Employed/Contracted providers asapplicable and ensures that professional credentialing records are kept current and complete asrequired by licensure authorities, regulatory agencies and managed care contract organizations.

4. Performs all phases of professional billing credentialing for all new Employed/Contracted providers asapplicable and ensures that professional credentialing records are kept current and complete asrequired by licensure authorities, regulatory agencies and managed care contract organizations.

5. Prepares credentialing applications for Employed/Contracted providers as applicable for Medicare,Medicaid and all insurance carriers and managed care contracts. Carefully reviews applications foraccuracy and includes all required addendums or attestations. Forwards completed application toprovider for signature and follows up closely to ensure timely return of signed application. Submitscompleted application to managed care organizations and other payer agencies.

6. Maintains and re-attests CAQH credentialing data for practitioners not covered under the managed care delegated credentialing agreements.

7. Maintains log to track status of credentialing activities. Tracks and follows up with managed careorganizations and other payer agencies to ensure all information requested is supplied and timelyresponses are provided.

8. When received, records provider billing number in credentialing software and appropriate insurancematrix. Notifies the appropriate designated individuals within professional billing departments of theprovider's approval, as appropriate. Forwards current license, registrations, certifications andinsurance to Managed Care organizations as requested.

9. Maintains professional relationships with the Medical Staff, department directors, departmentmanagers, managed care staff, administrative staff and representatives of managed careorganizations. Prepares, sends, and tracks correspondence for verification, reappointments, andother routine items that support the Provider Enrollment credentialing functions, and other duties
essential to the smooth functioning of the Medical Staff Services department.

10. Performs all phases of professional billing credentialing for all new T Employed/Contracted providers as applicable and ensures that professional credentialing records are kept current and complete asrequired by licensure authorities, regulatory agencies and managed care contract organizations.

11. Prepares credentialing applications for Employed/Contracted providers as applicable for Medicare,Medicaid and all insurance carriers and managed care contracts. Carefully reviews applications foraccuracy and includes all required addendums or attestations. Forwards completed application toprovider for signature and follows up closely to ensure timely return of signed application. Submitscompleted application to managed care organizations and other payer agencies.

12. Maintains and re-attests CAQH credentialing data for practitioners not covered under the managedcare delegated credentialing agreements.

13. Maintains log to track status of credentialing activities. Tracks and follows up with managed careorganizations and other payer agencies to ensure all information requested is supplied and timelyresponses are provided.

14. When received, records provider billing number in credentialing software and appropriate insurancematrix. Notifies the appropriate designated individuals within professional billing departments of theprovider's approval, as appropriate. Forwards current license, registrations, certifications andinsurance to Managed Care organizations as requested.

15. Performs a variety of administrative duties such as typing correspondence, answering phones, filing,scanning, and making copies.

16. Promotes quality improvement, staff and patient safety, and cultural diversity through departmentoperations and by personal performance.

17. Presents a courteous and helpful demeanor, appropriate for age, to all patients, visitors, otheremployees/medical staff members, or any other person an employee encounters while representingthe organization.

18. Maintains current knowledge related to applicable statutes, regulations, guidelines and standardsnecessary to perform job duties in accordance with the requirements of the Corporate CompliancePlan. Complies with the requirements of the Code of Conduct, Corporate Compliance Plan and
Compliance Policies and Procedures, including training requirements. Participates in complianceactivities under the direction of the Department Director and Corporate Compliance Officer.

Minimum Requirements:
1. High school diploma or equivalent GED
2. 2 years previous experience in hospital or medical office credentialing or related area (2 years in
managed care credentialing or 2 years in a hospital/medical office)
3. Experience working with practitioner administrative related activities
4. Excellent computer knowledge and competency
5. Demonstrate attention to detail and accuracy
6. Possess the ability to work constructively with physicians, professionals, and others.
7. Manage multiple tasks and meet deadlines
8. Ability to exercise a high degree of independent judgement in carrying out detailed diligence in
credentialing activities.

Preferred Requirements:
1. Previous experience in an academic medical center setting working with physicians and administrative
matters.