Credentialing Specialist

Job Description

Job Description

Credentialing Specialist

Noble Community Clinics is seeking an Credentialing Specialist to join our team. This position plays an important role in ensuring our providers and clinic locations maintain active participation with insurance payers and remain compliant with enrollment and contracting requirements.

The Credentialing Specialist manages provider and site enrollment, payer contracting, revalidation, and credentialing-related activities. This role works closely with providers, internal departments, insurance payers, and external partners to ensure enrollment information is accurate, current, and completed within required timelines.

Provider Enrollment & Credentialing

• Complete enrollment for new providers with applicable insurance payers and clearinghouses in a timely and accurate manner.
• Utilize Credential Stream to maintain, track, submit, and initiate provider enrollment and demographic information.
• Maintain CAQH proxy access on behalf of providers.
• Track provider, site, and contract renewals and expiration dates to prevent enrollment lapses.
• Coordinate payer revalidations, renewals, and enrollment updates.

Payer Contracting & Relationships

• Establish and maintain professional relationships with insurance payer contacts.
• Serve as an organizational contact for payer enrollment and contracting questions and issues.
• Research payer requirements and develop guidelines for new provider and site agreements as needed.
• Monitor payer requirements and communicate changes to appropriate internal departments.

Issue Resolution & Compliance

• Track, research, and assist with resolving enrollment-related denials, adjustments, and payer issues.
• Assist with enrollment-related appeals and payer escalations.
• Identify and escalate outstanding or pending enrollment and contract issues.
• Maintain knowledge of payer requirements and the unique regulatory and operational requirements of Federally Qualified Health Centers (FQHCs).
• Maintain patient confidentiality and comply with HIPAA requirements.

Collaboration & Customer Service

• Partner with internal departments to resolve enrollment and payer-related issues.
• Provide responsive, professional customer service to providers, coworkers, payers, and other external partners.
• Maintain a positive and professional image of Noble Community Clinics.

• High school diploma or equivalent required.
• Previous payer enrollment, credentialing, or payer contracting experience preferred.
• Strong computer skills, including proficiency with Microsoft Office applications required.
• Excellent organizational skills and attention to detail.
• Strong analytical and problem-solving abilities.
• Excellent time management skills and the ability to meet deadlines.
• Strong interpersonal and communication skills.
• CPR certification required within six months of hire.

At Noble, you'll be part of a mission-driven organization focused on providing accessible, high-quality healthcare to the communities we serve. Your work will directly support our providers and help ensure patients have continued access to care.

Benefits may include:

• 20 days of PTO (accrual starts on day one)
• 8 paid holidays
• 401(k) with up to 5% employer match
• Medical, dental, and vision insurance
• Employer paid Short- and long-term disability and life insurance

Noble Community Clinics is an Equal Opportunity Employer.