- Manage end-to-end credentialing and recredentialing processes for new and existing providers, including verification of education, training, board certifications, and work history.
- Coordinate payer enrollment applications and updates to ensure timely processing and provider participation across commercial and government payers.
- Maintain accurate and up-to-date credentialing files and records in compliance with internal standards and regulatory requirements.
- Collaborate with providers, health plans, and internal departments to resolve any credentialing-related issues or delays.
- Track credentialing timelines and proactively follow up on outstanding applications or documentation.
- Ensure compliance with NCQA, CMS, state, and payer-specific regulations and standards.
- Participate in audits, surveys, and reporting related to provider credentialing and enrollment.
- Support cross-functional teams including clinical operations, revenue cycle, and human resources with credentialing-related information and processes.