Provider & Practice Onboarding
- Execute credentialing and enrollment workflows for:
- New providers joining existing practices
- New and relocated practice locations
- New groups, acquisitions, and TIN transition projects
- Prioritize Medicare enrollment across all applicable workflows
- Create and maintain CPSRs (Credentialing Provider Status Reports) to track payer progress and communicate updates
- Send provider welcome communications within required timeframes, including instructions for CAQH, CMS systems, and document submission
- Coordinate payer and CMS surrogacy requests as required
Data & Systems Management
- Maintain accurate, current provider and practice data in:
- Credentialing Database / Practice Master Sheet
- CAQH Provider Profiles
- CMS Systems (PECOS & NPPES)
- Secure document repositories (OneDrive / SharePoint)
- Create, update, and manage payer-specific and administrative tasks in Wrike
- Ensure all credentialing files are complete, organized, and audit-ready
Recredentialing & Ongoing Monitoring
- Complete Medicare revalidations, Medicaid recredentialing, and commercial recredentialing per payer schedules
- Monitor payer portals and respond to interim or ad-hoc recredentialing requests
- Proactively establish future assignments based on next revalidation cycles
Provider Updates & Terminations
- Process provider and location terminations within payer-required timeframes
- Coordinate with Operations and Revenue Cycle Management to minimize claims disruption
- Manage provider demographic updates (e.g., name changes) and ensure consistency across all systems and payers
Inquiries & Cross-Functional Support
- Resolve practice and internal inquiries submitted via Wrike with clear, timely communication
- Support Revenue Cycle Management with credentialing-related billing inquiries
- Address credentialing-related RCM holds and escalate unresolved issues appropriately