• Own and manage the full lifecycle of clinical credentialingfor Porter’s clinical workforce.
• Verify provider qualifications, including licenses, certifications, education, training, work history, malpractice coverage, and other required credentials.
• Conduct primary source verification and maintain accurate, complete, and audit-ready provider credentialing files.
• Manage credentialing requirements for Nurse Practitioners, Registered Nurses, Licensed Practical Nurses, and other clinical professionals.
• Monitor provider licenses, certifications, registrations, malpractice insurance, and other time-sensitive credentials to ensure compliance with applicable requirements.
• Proactively track expirables and initiate renewal processes well in advance of expiration dates.
• Identify and resolve credentialing discrepancies, gaps, and compliance issues, escalating concerns when appropriate.
• Coordinate provider enrollment and credentialing activities with health plans, payers, healthcare organizations, and other external partners as needed.
• Guide clinical providers through credentialing, onboarding, and related compliance requirements, serving as a knowledgeable resource throughout the process.
• Partner with Clinical Operations, HR, Compliance, and leadership to ensure providers are appropriately credentialed and cleared before providing patient care.
• Maintain accurate provider information and credentialing documentation within internal systems and databases.
• Develop, document, and continuously improve credentialing workflows, processes, checklists, and standard operating procedures.
• Monitor credentialing timelines and performance metrics to ensure requirements and deadlines are consistently met.
• Support internal and external audits by maintaining organized, accurate, and readily accessible credentialing documentation.
• Stay current on applicable healthcare regulations, credentialing standards, payer requirements, and state-specific licensing requirements.
• Identify opportunities to improve efficiency, reduce credentialing delays, and enhance the overall provider onboarding experience.
• Serve as a subject-matter expert and resource for clinical credentialing across the organization.