What are the responsibilities and job description for the Credentialing Specialist ( MEDICAL) position at Premier Medical?
PREMIER MEDICAL ASSOCIATES
- Review new applications and supporting documents in a virtual environment and apply policy and criteria required for credentialing processing.
- Perform all required primary source verifications.
- Contact hospitals, licensing agencies, malpractice carriers, and medical schools to obtain credentialing verifications.
- Maintain and update credentialing database records.
- Review malpractice history, regulatory and disciplinary action reports issued by state and federal agencies invoking appropriate processes as defined in policies and procedures.
- Review the CAQH system and download applications or supplemental documents as appropriate.
- Maintain electronic provider files.
- Perform outreach to providers and facilities via phone calls and fax/email correspondence.
- Demonstrate knowledge of credentialing regulatory and accreditation requirements (NCQA, CMS, Medicaid, etc.).
- Perform other duties as assigned.