Credentialing Assistant
Posted 2 hours ago
Worldwide
⭐
0-2 years experience
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AI Summary
The Credentialing Assistant provides administrative support by managing credentialing communications, facility recredentialing outreach, and application intake. They are also responsible for maintaining provider records in Salesforce and monitoring expired licenses to ensure departmental compliance.
The Credentialing Assistant provides administrative and operational support to the Credentialing Department by managing credentialing communications, facility recredentialing outreach, application intake and completeness screening, provider termination support, provider record maintenance, and license monitoring activities in accordance with established departmental procedures. The role is responsible for timely and accurate documentation in Salesforce, appropriate escalation of issues, and ensuring work is ready for processing by the Credentialing Coordinators.
PRINCIPAL ACCOUNTABILITIES
1. Email Management & Credentialing Communications – 20%
- Monitor credentialing email activity each workday, including morning and afternoon review.
- Respond to all credentialing emails within 24 hours.
- Send credentialing-related email communications through Salesforce in accordance with department procedure.
- Escalate urgent or unresolved matters to the Credentialing Coordinator or Manager, as appropriate.
- Maintain clear and timely documentation of communications and follow-up activity in Salesforce.
2. Facility Recredentialing Outreach & Follow-Up – 25%
- Initiate facility recredentialing outreach according to the established SOP timeline:
- 90 days before the recredentialing due date: send the initial outreach email.
- 60 days before the due date: send the follow-up outreach email.
- 45 days before the due date: make the final outreach attempt by telephone.
- Document all outreach and follow-up activity in Salesforce.
- For facility recredentialing that remains incomplete after required outreach, update the provider status in Salesforce to 'F/U by PR' in accordance with the SOP.
3. Facility Recredentialing Application Intake – 20%
- Review facility recredentialing applications and submitted documents upon receipt.
- Screen all submitted materials for completeness before routing the file for credentialing processing.
- When all required documents are present, notify the Credentialing Coordinators that the application is complete and ready for processing.
- Maintain accurate documentation in Salesforce to support workflow visibility and handoff.
4. Provider Termination Support & Record Maintenance – 15%
- Process and complete all provider termination requests within three (3) business days of receipt.
- Run applicable Salesforce reports required to support termination activity.
- Remove providers from CAQH when required by the termination workflow.
- Remove the applicable provider association or location from Salesforce in accordance with established procedures.
- Update Salesforce to accurately reflect completed termination activity, including required status changes and documentation.
- Track termination requests from receipt through completion to ensure compliance with the three-business-day turnaround standard.
- Escalate any termination request that cannot be completed within three business days to the Credentialing Manager, including the reason for delay and outstanding action required.
5. Expired License Monitoring & Reverification – 20%
- Run the expired license report and review identified provider licenses.
- Reverify expired licenses in Salesforce using the provider record Credentials tab and the 'Click to Re-Verify' function.
- Review license verification results and distinguish active statuses (Active, Unencumbered, Registered) from inactive statuses (Lapsed, Inactive, Not Found, Expired, Suspended).
- If a license is expired in a state where the provider actively sees members, initiate the process to terminate that location/association in accordance with department procedure.
- If the provider remains active in another state, remove only the expired location/state as applicable.
- Communicate required location-removal actions to Provider Relations and document the action in Salesforce.
PERFORMANCE & WORKFLOW EXPECTATIONS
- Complete assigned activities accurately and within established departmental timelines and service-level expectations.
- Maintain complete, accurate, and current Salesforce documentation for all assigned work.
- Follow the Credentialing Assistant SOP and escalate exceptions or unclear situations rather than deviating from the documented workflow.
- Maintain confidentiality of provider and organizational information.
- Support departmental workflow needs and participate in team meetings, training, and SOP updates as assigned.
QUALIFICATION REQUIREMENTS
- High school diploma or equivalent required.
- 0–2 years of experience in credentialing, provider data, provider contracting, network management, healthcare administration, or a related support function preferred.
- Experience with provider file maintenance, data entry, document review, or high-volume administrative workflows preferred.
- Ability to manage multiple assignments, meet deadlines, and maintain accuracy in a high-volume environment.
- Strong written and verbal communication skills.
- Proficiency with Microsoft Excel and general office applications.
- Experience with Salesforce or similar workflow/database systems preferred.
KEY SYSTEMS / WORK TOOLS
- Salesforce
- CAQH
- Microsoft Outlook / Email
- Microsoft Excel
- Department reports, work queues, and credentialing tracking tools
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