Credentialing Specialist

Job Description

Job Description

Description:

FLSA Status: Non-Exempt 

Department: Revenue Cycle Management

Reports To: Credentialing Manager

Last edited: January 2025

Position Summary:

The Credentialing Specialist is responsible for supporting various initiatives across the credentialing team, including assisting with provider enrollments, maintaining CAQH profiles, obtaining and reviewing physicians’ medical licenses, helping with hospital privileging, and completing and processing credentialing applications. This position requires a high degree of organization, assertive, yet professional communications, accuracy and timely completion of assignments. 

Principal Duties and Responsibilities:

Data Collection & Management

• Collects provider credentials and updates internal and external databases
• Reviews and streamlines processes and workflows for the on-boarding department, using automation where appropriate
• Interacts with varied levels of management, physician office staff and physicians effectively to accomplish credentialing and various elements

Project Management

• Maintain up-to-date data for each provider in credentialing databases and online systems
• Maintain accurate provider rosters for insurance companies
• Track completion of CAQH and when re-attestations are due for each provider
• Track expirables, such as medical licenses, DEA, CDS
• Notify administration, billing, and operations of the effective dates for providers 
• Interact with varied levels of management, physician office staff and physicians effectively to accomplish credentialing. 
• Maintains confidentiality of provider information
• Initial Hospital and Reappointment Applications 

Necessary Skills and Abilities:

• Extremely responsive, detail-oriented, and organized.
• Ability to perform a variety of duties within any workday 
• Team approach to working with others
• Project coordinating experience
• Demonstrates tenacity and initiative
• Analytical and organized
• Self-starter and independent problem-solver 

Physical Requirements:

• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job
• The employee must be able to remain in a stationary position at least 50% of the time. The employee needs to occasionally move about inside the office to access file cabinets, office machinery, etc.
• While performing the duties of this Job, the employee is regularly required to use hands to grasp, handle, or feel; reach with hands and arms. Hearing and visual acuity are also required.
• The employee will constantly be operating a computer and other office productivity machinery, such as a calculator, copy machine & printer.
• The employee may occasionally be required to lift and or move up to 20lbs by themselves.

Notes:

• Reasonable accommodations may be made to perform the essential functions
• This job description describes the ideal candidate for this position and in no way implies any limits to a person’s desire to apply
• To meet the needs of the company, employees may be assigned other duties, in addition to or in lieu of those described above
• Any duties are subject to change at any time
• This document does not create an employment contract, implied or otherwise, other than an “at-will” relationship

Requirements:

The successful candidate will have the following experience or knowledge in the following areas:

0-2 years’ experience in managed care credentialing, billing and/or Medical Staff service setting

High School Diploma or equivalent

Previous experience working in a medical office, preferred

Working knowledge of medical terminology, billing, insurance a plus

Demonstrated skills in problem solving analysis and resolution

Attention to detail

Must comply with HIPAA rules and regulations