Credentialing Support Specialist | PAM Health Corporate

About the role

The Credentialing Support Specialist supports the completion of Credentialing and Re-credentialing material submitted to Managed Care Organizations, providing evidence of fully qualified facilities in PAM Health’s Rehabilitation Hospitals, Long Term Acute Hospitals, and Psychiatric Hospitals. This role gathers and communicates data progress regularly to ensure operational readiness and network participation for approximately 72 Post Acute centers in 18 states. The position reports to the Administrator Managed Care Credentialing and provides administrative support and project work to the Managed Care Department as needed.

Responsibilities

• Complete credentialing and re-credentialing applications, specifically tracking and initiating renewals at least 60 days prior to expiration.
• Maintain robust records of credentialing communications, submissions, and approvals.
• Proactively communicate with payors to ensure end-to-end credentialing cycles.
• Verify and audit provider directory information within payor databases.
• Audit internal credentialing databases.
• Coordinate urgently when facilities present overdue credentialing to complete re-credentialing requirements, as failure to re-credential can result in health plan contract termination.
• Support external and internal communications efforts to accelerate the credentialing process.
• Prepare rosters for submission to payors.
• Coordinate with Administrator Managed Care Credentialing to collect, verify, and organize necessary documentation for applications.
• Troubleshoot and resolve issues that may hinder timely participation with plans.
• Support efforts to understand re-credentialing 3-year time frames and anticipate the need for timely re-credentialing before Health Plans initiate it.
• Maintain the highest level of customer service via courtesy, compassion, and positive communication.
• Support the Managed Care Team and PAM Health Facilities in a timely fashion regarding all aspects of credentialing support and follow-up.
• Promote the mission and vision of PAM Health within the work environment and the community.
• Respect dignity and confidentiality by adhering to all applicable policies and procedures.
• Work in a manner that promotes safety, wear appropriate clothing, and participate in OSHA-required training.
• Follow universal precautions as appropriate for the position and comply with Employee Health requirements for continued employment.
• Report unsafe practices to management.
• Perform other duties that support the Managed Care Department as assigned.

Requirements

• Associate’s Degree in Health or Business Administration preferred. High School diploma or GED with two (2) or more years of relevant work history will be considered.
• PESC certificate through an applicable organization is a plus.
• Two (2) or more years of experience in healthcare enrollment, credentialing, or medical practice operations.
• Experience in a role requiring high-volume data collection and stakeholder communication.

Skills

• Proven track record of managing data with sharp attention to detail, critical for success in this role.
• Strong proficiency with MS 365 applications (Excel, Word, Outlook, PowerPoint) and PDF editing.
• Ability to multitask, covering multiple markets and facilities.
• Critical thinking to analyze projects/problems and work through them effectively.
• Ability to manage time and prioritize work/projects.
• Demonstrated professionalism and exceptional interpersonal, written, and verbal communication skills.
• Healthcare facility enrollment experience preferred.
• Basic familiarity with Insurance Plans and Medical Databases.
• Ability to adhere to strict confidentiality guidelines and operate with the utmost integrity and discretion.
• Teamwork: able to follow through with delegated tasks and accountability.
• Learning-focused, dedicated to results, and thorough follow-up.
• Knowledge of commonly used credentialing concepts, practices, and procedures (Primary Source Verifications, Designated Equivalency Sources, Malpractice History, etc.).
• Demonstrated ability to function independently with minimal direct supervision.