Responsible for collecting and maintaining provider credentials necessary to ensure initial credentialing and re-credentialing with Medicare, Medicaid, and Commercial Insurance Plans. Tracks enrollment applications from submission through participating status completion. Enters specialized applicant information into a complex database and coordinates the credentialing process with the provider applicant, human resources, hospital medical staff offices, and the clinical department.


Principal Accountabilities:

Atlantic Medical Group is seeking a Full Time Credentialing Specialist. The Selected candidate will be responsible for review of the submitted onboarding application for completeness and performing appropriate follow up with practitioner for missing information.

• Prepare document checklist. Establish a rapport with the physician and practice manager to gather missing items in order to ensure applications are released in a timely manner.
• Maintains physician credentials necessary to ensure initial and continued enrollment into participating insurance plans, Medicare (PECOS) and Medicaid.
• Submit payer enrollment and follows up on credentialing applications per established follow up time frames. Tracks applications and correspondence with insurance plans through to final completion. Alerts management of any concerns.
• Provides routine reports on the status of participation in insurance plans.
• Updates and maintains the ECHO and CAQH databases.
• Process demographic updates and ensure database is kept accurate and updated. Audits health plan directories/portals for current and accurate provider information.
• Tracks license and certification expirations for all providers to ensure timely renewals
• Undertakes special projects and assignments as directed by the manager.
• Performs other duties as assigned.