Lillian S.

Coordinates the expedient handling of the credentialing and re-credentialing process according to regulatory and accreditation standards, where required. Performs updates to physician, institution and ancillary provider credentialing files. Compiles all relevant information(eg.member/healthcare provider complaints, utilization management findings,licensing issues,sanctions,malpractice cases)and ensures inclusion in the credentialing and re-credentialing file. Reviews and prepares all final credentialing and re-credentialing files prior to submission to the insurance carriers to ensure all required elements are present. Create letters to ensure notification to healthcare professionals of timely licensure and certification. Oversees that departmental records and files are maintained. Files, scans, data enters, organizes and verifies documents within the unit. Updates provider’s files and notifies billing departments when necessary. Completes other assigned functions as requested by management.