Professional Services Contracting and Credentialing Director
3 days ago
The Auctus Group is seeking a seasoned Contracting & Credentialing Team Lead to lead our contracting and credentialing function. As a key member of our team, you will be responsible for ensuring compliance with regulatory requirements, developing strategic partnerships with external stakeholders, and driving business growth and improvement.
The ideal candidate will have 1-3 years of experience in contracting and credentialing, with knowledge of organizational effectiveness and operations management. Experience in a multi-entity organization in the healthcare industry is an added advantage.
- Key Responsibilities:
- Conduct all follow-up steps until payor approval/completion is obtained
- File provider practice change notifications and perform follow-up duties till confirmed complete by payors
- Update NPI records according to provider specifications
- Enroll providers in Medicare/Medicaid as prescribed by each program requirements
- Track provider licensure and board expirations and ensure timely processing CAQH, and payor updates
- Complete requests for re-credentialing for both providers and facilities
- Accept and process all requests from payers for credentialing information/updates/new contracts and products
- Answer questions, process requests from staff/providers related to credentialing information
- Address enrollment disconnects regarding facility and providers
- Complete ERA/EFT enrollment, tracking and filing, clearinghouse (Availity RCM, CAQH, Enroll hub etc.)
- Maintain quarterly CAQH mass attestation
- Serve as liaison between outside organizations and external customers
- Manage the creation/maintenance of our Availity, Optum & Medicare as it pertains to usage by providers & third-party users
- Submit accreditation applications and follow up until approval is obtained
- Knowledge of licensing application processes across different states
- Proficiency in creating Group NPI (GNPI) and Individual NPI (INPI) through NPPES
- Familiarity with Modio, Pipedrive, and LastPass is a plus
- Experience in submitting hospital privileges/initial appointment applications and managing follow-ups until approval
- Experience in submitting and tracking DEA applications until approval
- Experience in maintaining the Provider's CAQH
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