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Credentialing Specialist - 28257-1
50 Beale Street San Francisco, California 94105 | Contract
Day to Day Responsibilities of this Position and Description of Project:
Responsible for all activities associated with credentialing or re-credentialing providers for the HMO and PPO network. Duties may include processing provider applications, research, verifications and preparation of files for Credentialing Committee review. Communicates with internal departments and external sources to exchange information and verify data.
- Gathers data, reviews for completeness and accuracy, analyzes potential problems and recommends appropriate actions. Monitors timeliness and receipt of information and follow up as needed.
- Identifies any issues in the files and refers for further research.
- Enters credentialing data into system and tracks and maintains provider information.
- Performs general office duties such as filing, duplicating, sorting, mail distribution, etc.
- Works with internal department to exchange provider information and follows up on inconsistencies.
- Identifies procedural and systems problems and brings them to Supervisor' s attention; makes recommendations where appropriate.
- Assists with expirables updates licenses and specialty boards.