Essential Duties and Responsibilities:
· Ensure accurate and timely completion, submission, and follow-up on all outstanding credentialing/re-credentialing applications with payers and hospitals.
· Collect primary source verification documentation for initial credentialing, including licensing, board certifications, proof of professional liability insurance, and other necessary documents.
· Establish and maintain positive working relationships with payer representatives, hospital medical staff, internal departments, and providers.
· Maintain credentialing database and ensure information is up to date at all times.
· Notify staff upon completion of provider credentialing and plan participation status for scheduling and billing purposes.
· Prepare and maintain Texas Standardized Credentialing Application (TSCA), CAQH, and Availity for all providers.
· Complete NPPES (NPI), PECOS (CMS) and Texas Medicaid applications
· Verify that all credentialing requirements are met.
· Work with the billing department to resolve provider enrollment issues resulting in claim rejections/denials.
· Responsible for monthly submission of provider roster to health plans and timely communication of group additions, changes, and terminations.
· Stay abreast of regulatory requirements.
· Track continuing education credits for all providers.
· Adhere to HIPAA privacy regulations.
· Perform other duties as assigned.