Credentialing Specialist

Description FLSA Status: Non-Exempt Department: Revenue Cycle Management Reports To: Credentialing Manager Last edited: January 2025 Position Summary The Credentialing Specialist is responsible for supporting various initiatives across the credentialing team, including assisting with provider enrollments, maintaining CAQH profiles, obtaining and reviewing physicians’ medical licenses, helping with hospital privileging, and completing and processing credentialing applications. This position requires a high degree of organization, assertive, yet professional communications, accuracy and timely completion of assignments. Principal Duties And Responsibilities Data Collection & Management Collects provider credentials and updates internal and external databasesReviews and streamlines processes and workflows for the on-boarding department, using automation where appropriateInteracts with varied levels of management, physician office staff and physicians effectively to accomplish credentialing and various elements Project Management Maintain up-to-date data for each provider in credentialing databases and online systemsMaintain accurate provider rosters for insurance companiesTrack completion of CAQH and when re-attestations are due for each providerTrack expirables, such as medical licenses, DEA, CDSNotify administration, billing, and operations of the effective dates for providers Interact with varied levels of management, physician office staff and physicians effectively to accomplish credentialing. Maintains confidentiality of provider informationInitial Hospital and Reappointment Applications Necessary Skills And Abilities Extremely responsive, detail-oriented, and organized.Ability to perform a variety of duties within any workday Team approach to working with othersProject coordinating experienceDemonstrates tenacity and initiativeAnalytical and organizedSelf-starter and independent problem-solver Physical Requirements The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this jobThe employee must be able to remain in a stationary position at least 50% of the time. The employee needs to occasionally move about inside the office to access file cabinets, office machinery, etc.While performing the duties of this Job, the employee is regularly required to use hands to grasp, handle, or feel; reach with hands and arms. Hearing and visual acuity are also required.The employee will constantly be operating a computer and other office productivity machinery, such as a calculator, copy machine & printer.The employee may occasionally be required to lift and or move up to 20lbs by themselves. Notes Reasonable accommodations may be made to perform the essential functionsThis job description describes the ideal candidate for this position and in no way implies any limits to a person’s desire to applyTo meet the needs of the company, employees may be assigned other duties, in addition to or in lieu of those described aboveAny duties are subject to change at any timeThis document does not create an employment contract, implied or otherwise, other than an “at-will” relationship Requirements The successful candidate will have the following experience or knowledge in the following areas: 0-2 years’ experience in managed care credentialing, billing and/or Medical Staff service setting High School Diploma or equivalent Previous Experience Working In a Medical Office, Preferred Working knowledge of medical terminology, billing, insurance a plus Demonstrated skills in problem solving analysis and resolution Attention to detail Must comply with HIPAA rules and regulations