About this role
Job DetailsJob Location: 95-00-Corporate - Asheville, NC 28803Responsible for provider enrollment with payors to include: perform credentialing and re-credentialing related functions for all Allergy Partners providers on a national and state level with managed care companies, payors, and/or insurance carriers for new physicians and start-up practices. Serves as a resource and liaison to implement and resolve issues related to credentialing.
Responsibilities include, but are not limited to, the following:
Create and maintain licensing, credentials and insurance records
Conduct research on updated state and federal regulations and policies
Help develop internal credentialing processes
Monitor license and credential expiration dates and advise staff members of required “renew by” dates
Ensure the Providers and staff members are maintaining compliance with regulatory and accrediting institutions
Maintain tracking database for all credentialing activities
Completes provider credentialing and re-credentialing applications, nationwide; monitors applications and follow-up as needed
Maintain and monitor current state licenses, DEA licenses, malpractice insurance and any other required credentialing documents for all providers
Continual maintenance of provider files
Processes applications for credentialing and re-credentialing
Other Duties as assigned
OTHER
Completes all assigned AP training (such as CPR, OSHA, HIPAA, Compliance, Information Security, others) within designated timeframes.
Complies with Allergy Partners and respective hub/department policies and reports incidents of policy violations to a Supervisor/Manager/Director, Department of Compliance & Privacy or via the AP EthicsPoint hotline.
Typical Physical Demands Physical demands are moderate with occasional lifting of items weighing approximately 20 – 30 pounds; vision must be correctable to normal range and hearing acuity must be adequate to receive instructions and converse on standard telephone equipment; must have manual dexterity sufficient to operate a keyboard and other standard office equipment. Typical Working Conditions Normal office environment. Occasional evening or weekend work.
QualificationsEDUCATIONAL REQUIREMENTS
High School Diploma or GED required
QUALIFICATIONS AND EXPERIENCE:
Minimum 3 years' experience in credentialing field
Ability to meet strict deadlines
Attention to detail
Good communication skills
Knowledgeable in policies, laws and procedures
Strong computer skills
Proficiency in database management (if applicable)
Willingness to work as a team player
Good organizational skills
Knowledge of Credential Stream a plus
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