Credentialing Specialist

Job description

Description Evaluate, analyze, and coordinate all aspects of the credentialing and re-credentialing processes for practitioners practicing within the CAIPA Network. Provides integral support to healthcare operations by enabling timely onboarding of healthcare providers. Duties and Responsibilities: - Reviews and screens initial credentialing and re-credentialing applications for completeness, accuracy, and compliance with federal, state, local and Managed Care regulations, guidelines, policies, and standards. - Conduct primary source verification. Collects and validates documents to ensure accuracy of all credentialing elements; assesses completeness of information and qualifications relative to credentialing standards. - Identifies, analyzes, and resolves extraordinary information, discrepancies, time gaps, and other idiosyncrasies that could adversely impact the ability to credential and enroll practitioners; discovers and conveys problems to the Credentialing Manager for sound decision-making per CAIPA’s credentialing policies and procedures, federal, state, local and government/insurance agency regulations. - Monitors files to ensure completeness and accuracy; reviews all file...