Credentialing Specialist
Credentialing Specialist
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Salary Not Disclosed
1 Vacancy
Job Description
Job Description:
Purpose The Junior to Mid Credentialing Specialist supports the accurate and timely credentialing and recredentialing of healthcare providers with insurance networks clearinghouses and other credentialing bodies. This role involves assisting the Senior Credentialing Specialist in maintaining compliance ensuring accurate documentation and coordinating with insurance networks and other credentialing entities.
Key Responsibilities
Credentialing and Recredentialing Support:
Assist the Senior Credentialing Specialist in preparing submitting and tracking provider enrollment applications for insurance networks and credentialing organizations.
Ensure the accuracy and completeness of provider credentialing documentation including licenses certifications and insurance coverage.
Monitor and update credentialing timelines ensuring compliance with deadlines and payer requirements.
Compliance and Documentation:
Perform primary source verifications as directed maintaining adherence to regulatory and organizational standards.
Maintain organized credentialing records and ensure accurate data entry in credentialing software or databases.
Assist in audits of credentialing files to verify compliance with HIPAA and other regulatory requirements.
Communication and Coordination:
Act as a liaison between the Senior Credentialing Specialist healthcare providers and external entities to resolve credentialingrelated issues.
Follow up with providers payers and clearinghouses to gather required information or clarify discrepancies.
Communicate updates on credentialing processes and progress to the Senior Credentialing Specialist and management.
Administrative Support:
Provide support during highvolume credentialing periods including managing overflow tasks as assigned by the Senior Credentialing Specialist.
Prepare reports and summaries of credentialing activities for review by the Credentialing Manager or team.
Assist in training new team members on credentialing processes and software.
Required Knowledge and Skills:
Basic knowledge of credentialing processes and healthcare regulations.
Strong organizational skills with exceptional attention to detail and accuracy.
Proficiency in credentialing software and Microsoft Office Suite (Word Excel Outlook).
Excellent verbal and written communication skills for interacting with internal and external departments.
Ability to multitask and work collaboratively in a fastpaced environment.
Additional Requirements
Education: College or equivalent required; an Associates degree in healthcare administration or a related field is preferred.
- Experience:
At least 13 years of administrative experience preferably in healthcare or credentialing.
Familiarity with credentialing software and US payer processes is an advantage.
Attributes: Proactive teamoriented and capable of handling sensitive information professionally.
Work Environment
Officebased or remote depending on organizational needs.
May require flexibility during highdemand periods to meet deadlines.
Shift / Hours:
Monday Friday in one single shift 9:00 AM EST 6:00 PM EST. Note this is 12 or 13 Philippine time which will be 9:00 PM PHT 6:00 AM in PHT.
Employment Type
Full Time
