Credentialing Specialist

Key Responsibilities

• Efficient and timely completion of confidential Medicaid applications for provider enrollment, group affiliations, and ETIN enrollment/maintenance.
• Follow established timelines for processing and completion of applications.
• Critically evaluate application for any issues that may require special consideration, or additional review, and take appropriate action to resolve issue.
• Identify providers whom are due for ETIN recertification and escalate to supervisor appropriately.
• Cookordinate with appropriate credentialing onboarding staff to obtain required information from provider.
• Perform self-audit of work to ensure data integrity before mailing applications.
• Document all tasks, phone calls, emails and other forms of communication during the application process.
• Update rest of Medicaid team and onboarding platform once mailed.
• Assist to track the status of mailed applications, if needed.
• Provide status updates to Credentialing Department’s leadership within one business day, from receipt of request.
• Work with supervisor in identifying back-up coverage when out of the office.
• Timely and complete updates of credentialing software.
• Complete other related tasks or projects as assigned.
• Provide back-up to other Credentialing staff as necessary.

Qualifications

• Bachelor’s Degree in a Health-Related Discipline (Public Health, Healthcare Administrative, Health Service, Psychology or Sociology) highly preferred, or in process.
• High School Diploma Required.
• Hands on experience supporting healthcare credentialing and enrollment functions preferred.
• Notary a plus.