Credentialing Specialist

Job Summary:
We are seeking a detail-oriented and organized Credentialing Specialist to join our team. The ideal candidate will be responsible for verifying, maintaining, and completing healthcare provider credentials to ensure compliance with regulatory and organizational standards. This role involves working closely with insurance companies, healthcare providers, and credentialing agencies to facilitate the enrollment and re-credentialing process.

Key Responsibilities:

• Process initial credentialing and re-credentialing applications for healthcare providers.
• Verify provider qualifications, including licenses, certifications, education, training, and work history.
• Maintain up-to-date and accurate credentialing records in compliance with company policies and regulatory requirements.
• Work with insurance companies and healthcare networks to complete provider enrollment.
• Ensure compliance with accreditation standards, state regulations, and payer requirements.
• Investigate and resolve any credentialing issues or discrepancies.
• Track expiration dates for certifications, licenses, and insurance policies, ensuring timely renewals.
• Communicate effectively with providers, payers, and internal teams regarding credentialing status and requirements.
• Maintain confidentiality of provider information and adhere to HIPAA regulations.

Qualifications:

• Bachelor’s degree in a related field preferred.
• Minimum of 1 to 3 years of experience in credentialing, provider enrollment, or healthcare administration.
• Strong understanding of credentialing processes, regulations, and industry standards.
• Proficiency in credentialing software and databases.
• Knowledge of Medicare preferred.
• Excellent organizational skills and attention to detail.
• Strong communication and problem-solving abilities.
• Ability to work independently and meet deadlines in a fast-paced environment.
• Knowledge of HIPAA, CMS, NCQA, and Joint Commission standards is a plus.

Benefits:

• Competitive salary
• Health, dental, and vision insurance
• Paid time off and holidays
• Professional development opportunities