Credentialing Specialist

• Function as the primary liaison for all aspects of the provider onboarding process at Riverside Medical Group
• Verify credential documents, including VA Medical License, Federal DEA, Board Certification, and Visas
• Credential and recredential healthcare providers with contracted payors
• Review applications and monitor quality data and quality-control functions
• Complete and maintain provider applications for initial credentialing and re-credentialing/renewals, including necessary follow-up
• Ensure timely provider onboarding to mitigate patient access issues
• Release pending claims for newly credentialed providers in a timely manner
• Build, update, and maintain provider information in credentialing, CAQH, Echo, NPI, EMR/HER, and patient accounting systems
• Maintain provider information in internal and external directories according to CMS and regulatory guidelines
• Investigate credentialing issues involving payor participation, physician agreements, billing, place of service, CLIA, and NPI denials
• Respond to credentialing issues within 2 business days
• Research legal sanctions regarding licensure and report issues before malpractice submission or upon discovery
• Recommend best practices and process improvements in credentialing

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