Credentialing Specialist

Job Summary

Managing the full cycle of provider credentialing, the full-time Credentialing Specialist will ensure active status for all providers by completing credentialing packages for hospitals, surgery centers, and payers while maintaining accurate provider files and software systems.

Key responsibilities

• Manage the full cycle of provider credentialing with insurance carriers and maintain individual provider files
• Coordinate with practices on applications and renewals for all provider licenses and manage revalidation requests from government payers
• Develop and maintain policies and procedures related to credentialing and collaborate with billing staff to resolve authorization issues

Required qualifications

• Minimum of a High School Diploma or equivalent
• At least 1-2 years of experience in managed care credentialing
• Previous experience in a medical office is preferred
• Working knowledge of medical terminology, billing, and insurance is a plus
• CPCS Certification and MD Staff system experience are nice to have