Healthcare Credentialing Specialist

Healthcare Credentialing Specialist

Pinnacle Wound Management is a leading wound care provider dedicated to delivering high-quality patient care. We are seeking a detail-oriented Healthcare Credentialing Specialist to join our team. This role is critical in ensuring our healthcare professionals meet all necessary licensing, certification, and regulatory requirements. As a Healthcare Credentialing Specialist, you will be responsible for managing the credentialing and re-credentialing process for all of our physicians and mid-level healthcare providers. You will maintain accurate records, verify professional credentials, and ensure compliance with industry regulations and accreditation standards. If you are a meticulous and organized professional with a passion for healthcare compliance, we want to hear from you! Apply now to join us in ensuring the highest standards of wound care excellence!

Key Responsibilities:

• Maintain accurate and up-to-date provider files, ensuring compliance with all credentialing requirements
• Complete and track initial and re-credentialing applications for various health insurance portals, including CAQH, PECOS, NPPES, Navinet, Availity, PaySpan, CMS, and Managed Care Organizations
• Assist new providers with applications for National Provider Identifier (NPI), Medicare, and Medicaid numbers
• Monitor and update provider CAQH profiles in accordance with CMS and Managed Care Organization guidelines
• Manage termination of payer enrollments for providers leaving the organization
• Provide updated demographic information and supporting documents to external stakeholders, including commercial payers and billing entities
• Collaborate with the Director of Operations to ensure timely credentialing and re-credentialing of all providers
• Track and ensure the renewal of state DEA licenses, board certifications, and malpractice insurance
• Identify and resolve potential onboarding issues, offering solutions to streamline the credentialing process
• Maintain records of all managed care contracts and ensure portal logins remain active
• Ensure compliance with relevant accrediting and regulatory agencies
• Monitor trends and recommend improvements to credentialing workflows

Requirements:

• High school diploma or equivalent; credentialing certificate preferred
• Minimum of 5 years experience in physician credentialing, revenue cycle management, or related field
• Knowledge of credentialing standards and healthcare regulations
• Proficiency in credentialing software and Microsoft Office Suite
• Strong attention to detail, organizational, and problem-solving skills
• Excellent written and verbal communication skills
• Ability to work independently and manage multiple tasks efficiently

Benefits:

• 401k
• 401k matching
• Competitive pay
• Medical, dental, and vision insurance
• Paid time off
• Free parking
• No nights, no weekends
• Monday - Friday, 8 hour shift