Provider Credentialing Specialist

Job Summary

To ensure compliance and maintain provider data, the full-time remote Provider Credentialing Specialist will analyze credentialing applications, respond to inquiries regarding provider participation, and manage the provider file and workflow systems.

Key responsibilities

• Analyze credentialing applications and perform primary source verification for practitioner network participation
• Respond to internal and external inquiries about provider eligibility, status, and updates while ensuring a positive provider experience
• Maintain and update provider files and inventory workflow systems for credentialing, recredentialing, and demographic changes

Required qualifications

• High School Diploma or GED
• 3 years of experience in physician credentialing or health insurance/managed care operations
• Proficiency in Excel, including knowledge of Pivot tables
• Understanding of medical terminology and relevant jurisdictional requirements
• Certified Provider Credentialing Specialist (CPCS) preferred