Credentialing Representative

Position Summary

The Credentialing Representative processes the necessary paperwork with all required entities to ensure correct credentialing and billing.

Essential Functions

• Perform Primary Source verification on all providers utilizing credentialing software.
• Complete and submit credentialing applications for both providers and
• Maintain files with provider and facility
• Track information and submit
• Completing any re-credentialing application on the
• Completing and submitting group applications for any new locations or re-credentialing
• Submitting notification letters to plans for new locations or any updates to
• Assist other members of team as
• Initiate and maintain CAQH files on all Provider's.
• Communicate with multiple departments (Clinics, Billing, Collections) regarding provider status with health plan
• Audit reports based on information input into database software to ensure accurate information reporting out to various
• Attend meetings scheduled with Credentialing Leadership, other NextCare Departments, and health plan
• Document processes and procedures changes to payer enrollment on payer contact spreadsheet.
• Treats patients and co-workers consistent with the NextCare Mission Statement, Vision, Values and Performance
• Performs other related duties as assigned or described in Company
  
  

Essential Skills And Experience

Education: Minimum of High School diploma or equivalent

Experience: General computer skills required including experience using Microsoft Office, Adobe PDF, and OneNote (or equivalent). Prior provider enrollment credentialing experience. Written and verbal communication both internal and external.

Valued But Not Required Skills And Experience

Experience: Understanding of contracting processes. Understanding of revenue cycle in relation to credentialing. Previous experience using credentialing software. Experience using Credential Stream/Verity Stream Preferred.

Reporting To This Position

NA

Physical Demands And Work Environment

The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Physical Demands

While performing the essential functions of this job, the employee is occasionally required to stand; walk; sit; lift; carry; use hands to handle or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop; kneel, crouch or crawl, talk, hear and lift and/or move up to 40 pounds.

Work Environment

While performing the essential functions of this job, the employee will be exposed to working conditions commensurate with a traditional office environment.