• Complete credentialing and/or re-credentialing applications for physicians, ancillary providers and facilities or groups with third-party payers and governmental programs (Medicare and Medicaid) as requested by the client in an accurate and timely manner • Perform Primary Source Verification (PSV) services including but not limited to verification of licenses, malpractice and work history; perform PSV file audits as requested. • Complete, update and maintain Council for Affordable Quality Healthcare (“CAQH”) profiles for providers • Maintain a Credentialing database in accordance with BerryDunn’s policies and procedures for all participating and non-participating providers with payer identification numbers and effective dates • Partner with client liaisons, including billing departments to update the enrollment status of the providers • Contact payers to follow up on submitted applications within BerryDunn’s policies • Respond to various inquiries and requests for information from participating physicians, staff, hospitals, and managed care companies timely and with professionalism • Communicate with providers or their designees to obtain requisite credentialing information to facilitate timely completion and submission of required documents • Update client regularly on process and communicate any delays • Continuously inform Credentialing leadership of the project status and assist in managing expectations related to deliverables and deadlines • Be responsible for timely and accurately accounting of hours (billable and non-billable) in time and attendance software for proper billing of services rendered

• Monitor and manage participant appointment requests and schedules • Notify participants, caregivers, and POAs of scheduled appointments • Complete authorizations and referral documentation accurately • Coordinate scheduling, re-scheduling, and follow-up for outside appointments, labs, and imaging • Enter encounters for outside appointments in the medical records system • Process invoices and documentation for proper routing and payment • Answer phone calls and respond professionally to participant and referral inquiries • Communicate clearly with healthcare providers and staff regarding scheduling updates • Participate in team meetings and quality improvement initiatives • Adhere to established procedures and ensure all work is accurate, consistent, and complete

• Conduct all mandatory case review and quality assurance activities • Assure the efficiency of the case review process • Communicate with and support physician reviewers • Edit documentation for internal and external dissemination • Develop and maintain working relationships with community agencies

• Conduct an initial assessment of documentation from both the initiating and responding parties. • Review submitted documentation to identify missing documents and determine what is required to resolve the dispute. • Follow procedures to obtain the appropriate documentation. • Determine the appropriate type of clinical reviewer necessary to complete the case, such as a medical coder or a physician. • Prepare documents for the arbitrator reviewer assigned and provide instructions as needed. • Collaborate with the legal team to facilitate resolution of disputes. • Draft professional determination correspondence. • Perform quality assurance checks on determinations according to Federal or State guidance. • Audit and analyze patient records to ensure appropriate determination. • Stay current with regulation changes and perform research on a case-by-case basis. • Deliver high-quality, professional determinations free of grammar and spelling errors. • Amend reports with additional clinical information when necessary. • Participate in an interdisciplinary health care team to achieve positive outcomes.