Credentialing Specialist

• Credential and recredential NeighborHealth Center providers
• Ensure provider enrollment with participating client health plans
• Process credentialing applications and malpractice insurance applications
• Perform primary source verification
• Update and maintain the CAQH credentialing database according to internal policies, client health plan contracts, HRSA guidelines, and state and federal requirements
• Initiate and support provider application processes by sending, receiving, and analyzing provider documents and imported data for completeness
• Gather, verify, and evaluate confidential provider credentials according to departmental guidelines and accreditation standards
• Perform initial credentialing and recredentialing verification and ensure timely handoff or review and approval of provider files
• Respond promptly to provider, client health plan, and internal inquiries
• Monitor expiring licenses, board certifications, professional certifications, and other expirable documents
• Maintain provider paper and electronic files and submit provider data through CAQH
• Perform accurate data entry in credentialing databases
• Collaborate with HR to facilitate smooth handoff during credentialing
• Follow up with providers and internal and external entities to resolve discrepancies
• Monitor compliance and immediately alert HR of undisclosed negative findings
• Review, process, and distribute incoming correspondence, including mail, faxes, and email
• Keep HR and Billing Manager informed of potential credentialing or enrollment issues
• Perform other duties as assigned

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