Associate/ Sr. Associate-Credentialing

Job Overview: Responsible for all aspects of the credentialing, re-credentialing and privileging processes for all medical providers who provide patient service. Responsible for ensuring providers are credentialed, appointed, and privileged with health plans, hospitals and patient care facilities. Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications.

Job Profile:
1. Compiles and maintains current and accurate data for all providers.
2. Completes provider credentialing and credentialing applications; monitors applications and follows-up as needed.
3. Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
4. Maintains corporate provider contract files.
5. Maintains knowledge of current health plan and agency requirements for credentialing providers.
6. Sets up and maintains provider information in online credentialing databases and system.
7. Tracks license and certification expirations for all providers to ensure timely renewals.
8. Ensures practice addresses are current with health plans, agencies, and other entities.
9. Processes applications for appointment and reappointment of privileges to The Doctors Clinic (ASC). 10. Tracks license, DEA and professional liability expirations for appointed ASC providers.
11. Maintains ASC appointment files, and information in the credentialing database.

1. Maintains confidentiality of provider information.
2. Provide credentialing and privileging verifications.
3. Performs other duties as assigned.