Job Description

Credentialing Specialist

Essential Function and Responsibilities: Add, update and maintain accurate provider information in CAQH, CredentialStream and other tools commonly utilized for credentialing and payer enrollment. Work closely with providers, internal departments and other team members to obtain necessary information for timely onboarding. Complete, submit, document and pro-actively track and follow-up on required credentialing, enrollment and re-credentialing applications, paying close attention to details. Gather, compile and continuously monitor information necessary for enrollment and credentialing purposes. Update and inform department and other leadership of progress and issues using various means of communication. Research and respond to internal and external inquiries related to enrollment and credentialing issues. Maintain working knowledge of applicable regulations, policies and procedures and understand specific application requirements for both facility credentialing applications and payer enrollment submission. Work collaboratively in a team environment to achieve team and organizational goals by sharing information and resources. May assist other team members with the provider licensing and renewal process. Maintain a high level of confidentiality regarding legal matters, privacy issues and data integrity. Miscellaneous job-related duties as assigned.

Essential Qualifications: Education: Bachelor's degree, additional experience in lieu of education is accepted. Experience: 3-5 years of experience in a medical service profession, payer enrollment, insurance plan, revenue cycle, or a combination. Knowledge/Skills/Experience Must be accountable, organized and work independently to self-manage assignments. Knowledge and understanding of the credentialing process; ability to apply principles, procedures, requirements, regulations and policies. Effective communication and interpersonal skills for collaboration with internal teams and external stakeholders. Familiarity with CAQH, Availity, PECOS, NPPES and other common credentialing and payer enrollment tools. Thrive in a fast-paced, dynamic organization with the ability to work with and prioritize multiple assignments and deadlines while adapting to change as priorities shift. Express thoughts and information clearly, concisely and effectively both verbally and in writing. Critical thinker, anticipating next steps. CPCS certified a plus. Experience with CredentialStream preferred. Computer Proficiency, Microsoft Office to include Word, Excel, Power Point.

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