Assures the credentialing of healthcare providers is conducted in accordance with organizational policies, operational procedures, and applicable governmental and regulatory agency regulations and standards. Performs activities associated with verification, tracking inquiries, and follow-up on problems which may delay completion of the file.
- Obtains source verification of credentials in accordance with prevailing policies and procedures.
- Tracks responses and follows-up on items not received within established cycle periods.
- Reviews completed files with management in accordance with established schedules.
- Maintains credential records.
- Produces management reports regarding operations performance and/or provider credentialing status for internal management and external providers using the organization’s verification services.
- Adheres to operating policies and procedures including delivery of completed work and use of resources.
- Initiates correspondence to providers, users, health plans and others as necessary to obtain requisite credentialing information.
- Informs management regarding the status of departmental operations and provider credentialing issues of concern.
- Performs related duties, as required.
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