- Manage full-cycle provider credentialing and recredentialing processes in compliance with CMS, NCQA, and state regulatory requirements.
- Oversee medical payer enrollment activities, including submission of applications to commercial payers and government entities.
- Complete and manage PECOS and CMS 855i enrollments and updates.
- Maintain and track provider records and licensure expiration dates using Modio, ensuring data integrity and confidentiality.
- Research and interpret state-specific regulations, including Nurse Practitioner collaborative agreement requirements.
- Coordinate and manage collaborative agreements in accordance with state-specific requirements.
- Maintain provider data across platforms including CAQH, NPPES, PECOS, and payer portals.
HIPAA