In coordination with the Credentialing Director, leads the credentialing team members in daily Credentialing Operations such as credentialing, re-credentialing, system updates and ongoing monitoring according to State, Federal, external accreditation agency, and health plan requirements. Supervises credentialing staff in the daily management of the overall credentialing processes and database management. The Lead Credentialing Specialist will oversee the day-to-day operations of the credentialing specialists, will assist with escalations and takes the lead to back track credentialing concerns to external customers. The Lead Credentialing Specialist assists the Credentialing Director with all other special operational projects as needed.Â
Manages and participates in credentialing, re-credentialing, and ongoing monitoring processes for all providers. Ensure compliance with company standards, client requirements, State and Federal policies and regulations.
Manages and participates in credentialing, re-credentialing, and ongoing monitoring processes for all providers. Ensure compliance with company standards, client requirements, State and Federal policies and regulations.
Supervises credentialing specialists, including the assignment of duties, monitoring the work, training new staff members, and general management.
Participates in the implementation and expansion of credentialing process improvements including Intellisoft, CAQH, CMS and other processes that will improve efficiency, accuracy and uniform processes.
Along with the Credentialing Director performs quality and quantity reviews of credentialing department work to ensure department meets company quality and quantity standards.
Runs credentialing audits to ensure that contract compliance and requirements are met. Educate credentialing specialists on findings
Responsible for the prompt and accurate resolution of escalated issues from providers and internal inquiries. Communicates with the Credentialing Director to ensure escalation, delegation of work and information is communicated accurately and timely.
