Credentialing Assistant

The credentialing assistant will be a skilled professional with expertise in insurance follow-up. This role entails conducting weekly follow-ups for all commercial insurances selected by the client, ensuring comprehensive documentation is provided, and collaborating closely with insurance providers to facilitate the completion of enrollment (achieving in-network enrollment status) with each follow-up, as well as current contract inquiries.

Tasks:

Locate correct insurances on ‘Cred To Do’ spreadsheet, send inquiries for application and/or network status via phone call and/or email.

Maintain detailed status notes for each client based on the following status:

IF ENROLLMENT IS COMPLETE:

1. call reference/s

2. representative names and dates of call

3. provider/group IDs when applicable

4. provider effective date AND group effective date (these may differ)

5. date when the welcome letter was mailed out (and confirm mailing address)

IF ENROLLMENT IS STILL PROCESSING:

1. call reference/s

2. representative names and dates of call

3. detailed status and next steps (ask “what stage is the application currently in and what is the next step? When is this expected to complete?”)

When the insurance enrollment completes, provide proper documentation to the credentialing team

Credentialing Health Check inquiries- call each insurance chosen to find out the following:

1. Group Effective date

2. Request copy of contract (to be sent via email)

3. Request provider roster (showing all the providers who are linked to the group contract)

4. Group re-credentialing date

5. Request assigned clinic representative (if applicable) and record their phone # and email

6. Record group ID (when applicable)

7. Confirm servicing address/es