• Facilitate contract implementation by being proactive and reactive, with internal and external parties to ensure the public and private payer contract paperwork and credentialing is in alignment with corporate goals, contracts, and/or regulations.
• Prepare and maintain credentialing files and reports for all payors and government entities.
• Expand both government and commercial payor profiles to include all lines of business units due to mergers and acquisitions; complete updates required by contracts for credentialing, disclosure, and demographic information.
• Process and file applications with third party payors according to each payor’s individual requirements and addresses discrepancies, as requested, by payors.
• Conduct all follow up steps until payor approval, completion, and acceptance is obtained.
• Update NPI records according to provider specifications.
• Enroll provider in Medicare/Medicaid as prescribed by each program's requirements.
• Track licensure, accreditation, and insurance certificate expiration dates to ensure timely processing to be compliant with mandates for contractual agreements with state and federal regulations with payors.
• Complete requests for re-credentialing for payors, commercial, and government entities.
• Accept and process all requests from payers for credentialing information, updates, and new contracts and assays.
• Answer questions, inquiries, and process requests from all internal and external stakeholders related to credentialing information.
• Enroll all business units in Medicare/Medicaid programs.
• Address enrollment deficiencies and payor issues regarding commercial and government entities.
• Assist with electronic funds transfer (EFT) and electronic data interchange (EDI) enrollment, tracking, and filing.
• Serve as liaison between parent subsidiaries, third party billing agents, payors, commercial, Government entities, and all stakeholders to ensure revenue/reimbursement pull through.
• Maintain historical data and files.
• Interface with multiple departments to provide updates and stay abreast of current initiatives that could affect credentialing and enrollment.
• Monitor incoming emails for Odxclaimsupport, Payor Credentialing, GovTeam, ManagedCareContracts, Contact ManagedCare, and CommercialOpsFax.
