Angelica Raina

DUTIES AND RESPONSIBILITIES TO PERFORM THIS JOB SUCCESSFULLY INCLUDE, BUT
ARE NOT LIMITED TO THE FOLLOWING:

Completion of health care professionals credentialing and re-credentialing applications.
Maintain the credentialing database and ensure up-to-date information is obtained at all times.
Responsible for monitoring and managing expirables
OPPE Project Management.

Support the following committees: Physician Well Being; P & T; Antibiotic Stewardship; Blood Utilization; Nutritional Support
Attend monthly credentials and IDP committees meetings
Answer credentialing telephone line and provide support to physicians, physician office staff,
health plan contacts and company departments as necessary.
Assist with annual delegated credentialing audits

Monitor Proctoring across all departments.

Back-up: Ethics Consults

DUTIES AND RESPONSIBILITIES TO PERFORM THIS JOB SUCCESSFULLY INCLUDE, BUT
ARE NOT LIMITED TO THE FOLLOWING:

Completion of health care professionals credentialing and re-credentialing applications.
Data entry of new applications in the credentialing database.
Perform and collect PSV (primary source verification) documentation for licensing, board
certifications, proof of professional liability insurance, National Practitioner Data Bank (NPDB)
and/or other sources as required based on NCQA standards, health plan requirements and
company credentialing policies.
Maintain the credentialing database and ensure up-to-date information is obtained at all times.
Manage Expirables
Provide consistent and timely follow-up on all outstanding credentialing/re-credentialing files.
Support the IDP and Credentials Committee meetings.
Prepare credential committee grids and any adverse action documentation.

Peak Benchmark Quality Reporting
Answer credentialing telephone line and provide support to physicians, physician office staff as necessary