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Under general direction, is responsible for the initial and re-credentialing of providers as well as provider changes. Serves as the primary person to ensure accuracy and timing of the entire provider enrollment process from the time that the provider submits the credentialing or change information to the time the provider is enrolled in the appropriate Atrius Health systems.

• Accountable for the accuracy and timeliness of the entire process of obtaining, reviewing, submitting and tracking provider application, recredentialing and change paperwork. Expedites information gathering by working with individual clinicians as well as specialty administrators, chiefs and/or medical directors.

• Acts as liaison to physician recruitment and clinical practice supervisors/managers on matters related to credentials, licensure, hospital affiliations and provider numbers for assigned areas.

• Facilitates, tracks and follows through with paperwork needed for clinicians to obtain initial hospital privileges (appointments).

• Responsible for tracking license, DEA, malpractice face-sheet and other certification renewals as well as keeping current copies on file.

• Performs self-audit on credentialing work to assess quality, service and performance of end product to minimize the back and forth or phone calls from providers, payors and hospitals.

• Conducts proactive audits and system reviews to ensure the accuracy of provider information in all systems (e.g., data on Atrius Health website, credentialing database, credentialing fields in Resolute). Review and monitor standard reports to communicate back to the sites regarding enrollment of providers under the specialist’s jurisdiction.

• Identify areas of redundancy or areas that need to be standardized or streamlined vis a vis the payors, hospitals or changing industry standards. Brings issues to attention of supervisor and may make recommendations on improvements.

• Reports to specialty and practice location when clinicians are credentialed and entered into the appropriate system/s for scheduling and billing.

• Maintains complete and up to date credentialing file for all providers that require credentialing.

• Interacts with internal departments to ensure systems have the proper insurance information and that clinician credentialing is aligned with the terms of the payor contracts.

• Develops and builds collaborative relationships to handle queries or verifications, expedite processes and ensure clinician status changes are updated in an appropriate, timely fashion.

• Performs other duties as assigned.

SUPERVISORY RESPONSIBILITIES

None

Associates degree (or equivalent education, training or experience) required. Bachelor’s degree in Health Care Administration or related field preferred. National Certified Provider Credentialing Specialist Certification helpful, but not required.

At least three years of related experience in healthcare, preferably with at least 2 years in credentialing, contracts or 3rd party billing in a health plan or medical staff services setting required. Experience with Microsoft Office applications including Access, Excel and Word is a must.

Comprehensive knowledge and experience with Cactus credentialing database preferred.

Proven ability to manage and process detailed information. Successful candidate must possess excellent communication skills, both written and oral and must also display well-developed interpersonal skills in order to work successfully with all levels of management and staff both internally and externally. The ability to work independently is also required.