- Maintain accurate practitioner data, electronic files, and credentialing records in the credentialing database.
- Access and manage practitioner information through CAQH and paper application systems.
- Perform primary source verifications and maintain licensing, credentialing, certification, and insurance records.
- Track license, certification, insurance, and continuing education requirements, including expiration and renewal dates.
- Communicate with practitioners and internal stakeholders about application status, credentialing requirements, and outstanding documentation.
- Conduct credentialing and recredentialing in accordance with regulations, payer requirements, accreditation standards, and company policies.
- Monitor credentialing files and escalate delays, deficiencies, or compliance concerns.
- Maintain the confidentiality and security of practitioner information and credentialing records.
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