Credentialing Specialist
Position Summary:  This position is responsible for managing provider enrollment, credentialing, re-credentialing, and enrollment for multiple providers. The position maintains up-to-date data for each provider in credentialing databases and online systems and ensures timely license and certification renewals.
ESSENTIAL FUNCTIONS INCLUDE BUT ARE NOT LIMITED TO:

• Oversees the accurate collection of provider documents and information needed to contract and credential providers with insurance plans.

• Responsible for submitting initial and recredentialing applications to payers.

• Manages multiple provider CAQH profiles, responds and completes attestations and verification related to providers.

• Monitors applications and follows up as required and is able to respond to provider and department leadership related to the status of applications.

• Identifies and maintains relationships with payer representatives to assist in any issues.

• Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.

• Stay current on health plans.
• Tracks license, DEA and professional liability expirations for providers.

EXPERIENCE:
Two years of relevant payer enrollment, as well as CAQH and managed care contracting experience, is preferred.
SKILLS:

• Knowledge and understanding of the credentialing process.

• Ability to organize and prioritize work and manage multiple priorities.

• Excellent verbal and written communication skills, including letters, memos, and emails.

• Excellent attention to detail.

• Ability to research and analyze data.

• Ability to work independently with minimal supervision.

• Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization.

• Proficient use of Microsoft Office applications (Word, Excel, Access) and internet resources.

 

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