Credentialing Specialist

Base Pay $22.00 - $28.00 / Hour Job Category RCM, Credentialing Employee Type FT Non-Exempt Description About Us Aptiva Health is a rapidly growing, multi-specialty medical group with several locations throughout Kentucky and one in Indianapolis dedicated to delivering comprehensive orthopedic and acute-injury care through a collaborative, multidisciplinary model. Our teams — including surgeons, physical therapists, athletic trainers, neuropsychologists, mental wellness practitioners and diagnostic imaging technologists — work together to provide coordinated, patient-centered services ranging from general wellness and orthopedic services to sports medicine and concussion management to women’s pelvic health, dry needling, mental wellness and advanced imaging. Guided by our core values of transparency, fairness, innovation and hospitality, we’re committed to creating an unrivaled experience for providers, team members, and the communities we serve. Join us and help shape the future of healthcare in the region! Position Summary The Medical Credentialing Specialist manages provider and facility applications, verifies professional qualifications, monitors renewal deadlines, and keeps credentialing systems and records current. Working closely with providers and internal departments, the specialist helps resolve enrollment issues that could affect scheduling, compliance, or reimbursement. The ideal candidate is organized, detail-oriented, and comfortable managing multiple deadlines in a fast-paced healthcare environment. Key Responsibilities Coordinate initial credentialing and recredentialing for physicians, advanced practice providers, therapists, and other eligible healthcare professionals. Collect, review, and maintain provider documentation, including licenses, education and training records, board certifications, DEA registrations, malpractice insurance, work history, references, and other required credentials. Complete primary-source verifications, exclusion or sanction checks, and other required credentialing inquiries. Prepare, submit, and track enrollment and recredentialing applications for Medicare, Medicaid, commercial insurance plans, managed care organizations, and other payers. Maintain accurate and current provider information in CAQH, NPPES, PECOS, payer portals, credentialing software, and internal tracking systems. Monitor license, certification, insurance, CAQH attestation, revalidation, and recredentialing deadlines and follow up with providers before expiration. Assist providers with hospital or facility privileging, initial appointment, reappointment, and applicable licensure or registration updates. Follow up with payers, hospitals, providers, and other organizations regarding incomplete applications, outstanding documentation, processing delays, and effective dates. Process provider additions, terminations, relocations, demographic changes, and practice-location updates with applicable payers and facilities. Coordinate with Operations, Human Resources, Compliance, Billing, and Revenue Cycle teams regarding provider onboarding, credentialing status, participation dates, and credentialing-related claim issues. Maintain complete, accurate, confidential, and audit-ready electronic credentialing files. Prepare credentialing status reports and promptly escalated delays, discrepancies, or compliance concerns. Protect confidential provider and organizational information and comply with HIPAA, Aptiva Health policies, applicable regulatory requirements, and professional standards. Provide professional and responsive service to providers, payer representatives, hospital staff, and internal departments. Requirements Education, Skills, Experience and Knowledge High school diploma or equivalent required; associate degree in healthcare administration, business administration, health information management, or a related field preferred. At least one year of healthcare provider credentialing, recredentialing, payer enrollment, medical staff services, or closely related experience required. Working knowledge of provider credentialing, primary-source verification, payer enrollment, hospital privileging, and recredentialing processes. Familiarity with Medicare, Medicaid, commercial payer, and managed care enrollment requirements. Experience using CAQH ProView, NPPES, PECOS, payer portals, credentialing databases, and electronic document-management or tracking systems. Proficiency with Microsoft Office, particularly Outlook, Word, and Excel. Strong attention to detail and the ability to identify missing, inconsistent, or inaccurate information. Excellent organizational and time-management skills, with the ability to manage multiple providers, applications, and deadlines simultaneously. Strong written and verbal communication skills and the ability to communicate professionally with providers, payers, hospitals, and coworkers. Ability to work independently, exercise sound judgment, resolve routine credentialing issues, and follow assignments through completion. Ability to adapt to changing payer requirements, priorities, systems, and workflows. Demonstrated discretion and understanding of HIPAA, confidentiality, and appropriate handling of sensitive provider information. Certified Provider Credentialing Specialist (CPCS) certification preferred but not required. #J-18808-Ljbffr Kids for the Future