Job Description

1. Verify and maintain provider credentials , licenses, and certifications.
2. Perform primary source verification for educational, professional, and licensure credentials.
3. Manage provider enrollment with insurance panels and regulatory bodies.
4. Maintain accurate provider data in credentialing systems and databases.
5. Track credentialing expirations and manage timely re-credentialing.
6. Ensure compliance with state, federal, and organizational regulations .
7. Assist in audits, reporting, and documentation for internal and external reviews.
8. Communicate with providers, insurance companies, and internal departments regarding credentialing status.
9. Resolve credentialing discrepancies or missing documentation .
10. Collaborate with medical staff offices and administrative teams for smooth credentialing operations.

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