Job Description

Job Description

Job Description

Description:

The Credentialing Specialist position is responsible for ensuring that healthcare providers are properly credentialed and in compliance with all regulatory and organizational standards. This role involves verifying the credentials, licensures, certifications, and background of medical professionals to maintain compliance with industry standards and legal regulations.

Responsibilities include:

• Full-time, in office position. This is not a remote position.
• Credential newly hired clinicians with applicable insurance payers for timely billing.
• Collect, Submit, & Track all necessary documentation.
• Process re-credentialing for existing clinicians as required by individual payers.
• Maintain a current, accurate database of all clinicians’ credentialing / licensure status, needs, expirations, issues, etc. Share with internal staff as applicable.
• Communicate & Coordinate with all levels of internal staff & external stakeholders to ensure timely & consistent qualification is met & maintained.
• Monitor expiring credentials to ensure ongoing compliance with regulatory guidelines.
• Investigate and resolve any issues that arise during the approval process.
• Under the direction of leadership, assist with site level enrollments or changes to contract.
• Other duties as deemed necessary.

Requirements:

• 2+ years working in health plan enrollment is preferred
• High attention to detail including effective communications at all organizational levels
• Experience credentialing across multiple states as well as across Commercial and Medicaid payors
• Experience with state Medicaid enrollment is preferred
• Experience working in a team environment
• Demonstrated organizational skills and ability to adhere to timelines

Preferred but not necessary:

• Familiarity or experience with provider enrollment or medical licensing
• Startup experience

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