Job Description:
• Support providers through the privileging and credentialing process at acceptance of employment
• Initiate hospital credentialing for physicians and collaborate with UMass to maintain physician hospital appointments
• Maintain internal provider IDs, rosters, provider information, and NPI/PECOS access
• Support providers with applying for and renewing professional, DEA, controlled substance, and other required practice licenses and documentation
• Perform primary source verifications required by CMS, HRSA, Joint Commission, and NCQA
• Facilitate compliance trainings, CME's, and Life Support Trainings
• Re-credential providers for the Health Center and UMass
• Maintain accurate provider credentialing profiles in Cactus Cred software
• Track and report monthly on credentialing expirables
• Complete MassHealth and PECOS revalidation requests
• Complete credentialing applications for commercial payers, Medicare, and Medicaid
• Track and report provider enrollment progress
• Initiate and maintain provider CAQH database files according to CMS schedules
• Complete re-credentialing applications for commercial payers
• Collaborate with the Revenue Cycle Director and billing staff to resolve credentialing-related denials and authorization issues
• Create and maintain provider profiles in CAQH, PECOS, NPPES, MassHealth/C3, and CMS databases
• Perform other duties as assigned
Requirements:
• High school diploma, GED, associate degree, or bachelor's degree
• 2 years of credentialing experience preferred
• 2 years of experience in a medical practice business office role required
• Knowledge of provider credentialing and provider enrollment and their impact on the practice's revenue cycle
• Excellent computer skills, including Excel, Word, and Internet navigation for state and federal sites and health-plan searches
• Detail-oriented with strong organizational and time-management skills
• Ability to plan and prioritize to meet deadlines
• Excellent customer service skills
• Clear, effective, and professional communication
Benefits:
• Facilitate/support providers in obtaining compliance trainings, CME's, and Life Support Trainings when due