Credentialing Specialist

Department: Administration

Position Title: Credentialing Specialist

Reports To: Administration / Executive Management

Employment Status: Full-Time, Benefits Eligible

Work Schedule: Monday–Friday, 8:30 AM–5:00 PM

Location: 1055 N 300 W, Provo

The Credentialing Specialist is responsible for managing and coordinating all aspects of provider credentialing and recredentialing for 17 surgeons practicing in general surgery, plastic surgery, orthopaedic surgery, and other surgical specialties at Utah Surgical Associates.

This position ensures that all details involved in completing provider credentialing files are accomplished accurately, efficiently, and proactively. The Credentialing Specialist maintains provider credentials, hospital privileges, insurance payer enrollment, professional licenses, certifications, and related documentation.

Excellent organizational and interpersonal skills are essential. The ability to work effectively under time constraints, anticipate deadlines, and consistently meet required deadlines is extremely important to the success of this position.

The Credentialing Specialist must maintain excellent professional relationships with local healthcare facilities and insurance companies, both locally and nationwide, to successfully navigate their individual credentialing requirements and processes.

Essential Duties and Responsibilities

1. Provider Credentialing and Recredentialing

Manage initial credentialing and ongoing recredentialing for 17 surgeons across multiple specialties.

Ensure all details required to complete provider credentialing files are accomplished accurately, efficiently, and proactively.

Prepare, submit, track, and follow up on credentialing applications with hospitals, surgical facilities, and insurance companies.

Maintain current provider documentation, including medical licenses, DEA registrations, board certifications, malpractice insurance, and other required credentials.

Monitor expiration dates and initiate renewal processes well in advance of deadlines.

Maintain and update provider CAQH profiles, including required attestations.

Verify provider credentials through appropriate primary sources when required.

Identify and resolve missing documentation, discrepancies, and application delays.

2. Hospital and Healthcare Facility Privileges

Coordinate initial appointments, reappointments, and privilege renewals at hospitals and surgical facilities.

Maintain accurate records of each surgeon's approved hospital and facility privileges.

Work closely with medical staff offices to ensure timely completion of credentialing requirements.

Track deadlines and proactively address outstanding items to prevent interruptions in privileges.

Maintain excellent working relationships with local hospitals, healthcare facilities, and their credentialing personnel.

Understand and follow the unique credentialing processes and requirements of each facility.

3. Insurance Payer Enrollment and Credentialing

Manage provider enrollment, credentialing, and recredentialing with commercial insurance plans, Medicare, Medicaid, and other applicable payer networks.

Maintain professional relationships with insurance companies at both local and national levels.

Understand and follow the specific credentialing requirements, application procedures, and deadlines established by individual insurance companies.

Complete provider additions, terminations, demographic changes, and practice location updates.

Maintain accurate provider information, including NPIs, Tax IDs, addresses, and other required identifiers.

Track applications and communicate regularly with insurance representatives to resolve delays and outstanding requirements.

Coordinate with billing and administrative personnel to minimize disruptions to payer participation and reimbursement.

4. Organization, Deadline Management, and Compliance

Maintain a comprehensive and accurate credentialing tracking system.

Organize provider files, applications, correspondence, expiration dates, and renewal schedules.

Prioritize multiple projects and deadlines simultaneously.

Anticipate upcoming credentialing requirements and take necessary action without waiting for reminders.

Demonstrate the ability to work efficiently under time constraints while maintaining accuracy.

Ensure all applications and supporting documents are submitted within required timeframes.

Maintain confidentiality of provider and organizational information.

Ensure compliance with applicable credentialing policies, payer requirements, and regulatory standards.

Identify potential credentialing or compliance issues and notify management promptly.

5. Professional Communication and Relationship Management

Establish and maintain excellent working relationships with surgeons, hospital medical staff offices, surgical facilities, and insurance representatives.

Communicate professionally, courteously, and effectively with internal and external contacts.

Serve as the primary point of contact for credentialing-related questions and requests.

Obtain necessary information, documentation, and signatures from providers promptly.

Follow up consistently with facilities and insurance companies to ensure completion of credentialing processes.

Provide management with updates regarding application statuses, upcoming deadlines, and potential issues.

Work collaboratively with administrative, billing, and clinical personnel.

6. Computer and Administrative Responsibilities

Demonstrate proficiency in database management, spreadsheets, Internet research and navigation, Microsoft Word, and Microsoft Excel.

Maintain electronic credentialing records, databases, and tracking spreadsheets.

Utilize online credentialing systems, healthcare facility portals, payer websites, and CAQH.

Prepare and maintain accurate correspondence, reports, applications, and documentation.

Organize digital files and ensure information is readily accessible and current.

Learn and effectively use additional software programs and online systems as required.

Required Qualifications

Excellent organizational skills with exceptional attention to detail.

Strong interpersonal skills and the ability to establish and maintain positive professional relationships.

Demonstrated ability to work well under time constraints, manage competing priorities, and consistently meet deadlines.

Proficiency in database management, spreadsheets, Internet applications, Microsoft Word, and Microsoft Excel.

Excellent written and verbal communication skills.

Ability to independently manage multiple detailed processes from beginning to completion.

Strong follow-through, problem-solving abilities, and personal accountability.

Ability to maintain confidentiality and exercise sound judgment.

Ability to work independently with minimal supervision while contributing to a team environment.

Previous experience in healthcare credentialing, provider enrollment, or medical administration preferred.

Preferred Qualifications

Experience credentialing physicians in a multi-provider surgical practice.

Familiarity with general surgery, plastic surgery, and orthopaedic surgery.

Experience working with local hospitals, surgical facilities, and nationwide insurance companies.

Knowledge of CAQH, Medicare PECOS, Medicaid enrollment systems, and payer credentialing portals.

Understanding of applicable credentialing and regulatory requirements.

Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) certification.

Key Skills and Competencies

Organization and Attention to Detail: Maintains accurate and complete credentialing files and manages multiple detailed processes simultaneously.

Deadline Management: Understands the importance of time-sensitive credentialing requirements and consistently meets established deadlines.

Proactive Work Ethic: Anticipates needs, identifies potential problems, and initiates necessary actions without waiting for direction.

Interpersonal Skills: Builds and maintains excellent relationships with physicians, hospitals, healthcare facilities, insurance companies, and coworkers.

Computer Proficiency: Effectively utilizes databases, spreadsheets, Internet applications, Microsoft Word, Excel, and online credentialing systems.

Problem-Solving: Resolves credentialing issues, follows up on outstanding requirements, and works to prevent unnecessary delays.

Accountability: Takes ownership of credentialing responsibilities and follows through to successful completion.

Confidentiality and Professionalism: Handles sensitive information appropriately and represents Utah Surgical Associates professionally.

Performance Expectations

Successful performance in this position includes:

Maintaining complete, accurate, and current credentialing records for all 17 surgeons.

Ensuring credentialing and recredentialing applications are completed efficiently and proactively.

Meeting all required application, renewal, and expiration deadlines.

Preventing avoidable lapses in hospital privileges and insurance payer participation.

Maintaining positive, productive relationships with healthcare facilities and insurance companies.

Demonstrating strong organizational skills and reliable follow-through.

Working effectively under time constraints without sacrificing accuracy.

Communicating proactively with management regarding credentialing progress and concerns.

Supporting the efficient operation of Utah Surgical Associates.

Work Schedule and Benefits

This is a full-time position with benefits.

Typical Hours of Operation: Monday through Friday, 8:30 AM to 5:00 PM.

Eligible employee benefits include:

Health insurance

Dental insurance

Vision insurance

Pension plan

PTO

Benefits are subject to applicable plan documents and company policies.

Our Mission and Core Values

Purpose: Suffering Alleviated

Niche: Cutting Edge, Compassionate Surgical Care

Employees of Utah Surgical Associates are expected to demonstrate our core values:

Positivity

Kindness & Caring

Pioneer Work Ethic

Gratitude

Honesty

Additional Responsibilities

This job description describes the general duties, qualifications, and expectations of the Credentialing Specialist position. It is not intended to be an exhaustive list of all responsibilities. Additional duties may be assigned as necessary to support the operational needs of Utah Surgical Associates.

Job Type: Full-time

Work Location: In person