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The Credentialing Clerk is responsible for all aspects of the credentialing, recredentialing processes for all providers who provide client services. The Credentialing Clerk is responsible for ensuring providers are credentialed, appointed, and approved with all payor sources and facilities. The Credentialing Clerk will maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications.
- Compiles and maintains current and accurate data for all providers.
- Sets up and maintains provider information in online credentialing databases and system.
- Completes provider credentialing and recredentialing applications; monitors applications and follows-up as needed.
- Processes initial credentialing and re-credentialing applications.
- Works closely with the HR Coordinator to maintain copies of current state licenses, malpractice coverage and any other required credentialing documents for all providers.
- Maintains knowledge of current health plan and agency requirements for credentialing providers.
- Maintains corporate provider contract files.
- Tracks license and certification expirations for all providers to ensure timely renewals.
- Identifies discrepancies in information and conducting follow-ups.
- Assists with credentialing inquiries both internal and external.
- Captures primary source documentation in computer databases.
- Ensures compliance with applicable laws, regulations, procedures and policies.
- Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
- Other duties as assigned.
The Credentialing Clerk must have a high school diploma, GED, or suitable equilvalent and 2+ years of credentialing experience with healthcare professionals.