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Credentialing Specialist

Key Responsibilities:

Job Description:

  • Responsible for all aspects of new and existing provider credentialing and re-credentialing including initial application for all providers.
  • Complete credentialing applications to add providers to commercial payers, and Medicaid.
  • Review credentialing application for completeness and log any missing documentation
  • License Renewals: Ensures that physician licenses are renewed prior to expiration.
  • Records Management: Maintains assigned physician files, updating each item/action as processed
  • Ensure that information is current and accurate and ensure appropriate follow-up with Insurance carriers
  • Knowledge and experience with CAQH, Availity, NPI type 1 and 2.
  • Maintain confidential and sensitive information with discretion.
  • Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases

Required knowledge, skills and abilities:

  • Knowledge of provider credentialing with a minimum of two years of previous experience preferred
  • Excellent computer skills including Excel, Word, and Internet use 
  • Detail oriented with above average organizational skills 
  • Plans and prioritizes to meet deadlines 
  • Communicates clearly and effectively
  • Strong attention to detail and ability to manage multiple tasks simultaneously
  • Excellent communication and interpersonal skills, with the ability to work collaboratively with staff and providers.