Credentialing Specilaist

• Review new applications and supporting documents in a virtual environment and apply policy and criteria required for credentialing processing.

• Perform all required primary source verifications.

• Contact hospitals. licensing agencies. malpractice carriers. and medical schools to obtain credentialing verifications.

• Maintain and update credentialing database records.

• Review malpractice history. regulatory and disciplinary action reports issued by state and federal agencies invoking appropriate processes as defined in policies and procedures.

• Review the CAQH system and download applications or supplemental documents as appropriate.

• Maintain electronic provider files.

• Perform outreach to providers and facilities via phone calls and fax/email correspondence.

• Demonstrate knowledge of credentialing regulatory and accreditation requirements