Credentialing Specialist

A non-exempt position responsible for the accurate and timely processing of provider credentialing, enrollment, and re-credentialing for medical facilities and health plans. This role supports provider onboarding and ongoing compliance by coordinating with internal departments, practitioners, medical staff offices, and external payer entities to ensure credentialing requirements are met efficiently and in accordance with organizational policies. JOB FUNCTIONS: Initiate and support the credentialing application process by requesting, receiving and analyzing the provider’s documents for submission to the facilities for approval for medical staff privileges and payer credentialing/enrollment Collectively works with recruitment for onboarding practitioners and medical staff office team to assure practitioner’s credentialing process is efficient and timely Use critical thinking to conduct follow-up with individual practitioners, internal and external entities to resolve discrepancies identified during credentialing and enrollment process that may inhibit timely onboarding Manage all phases of payer credentialing/enrollment, re-credentialing/re-enrollment, notification of changes including termination of group practitioners Complete regular follow-up with the payers to ensure credentialing and enrollment is complete and escalated communication with payer provider enrollment staff of any issues prohibiting timely credentialing/enrollment Keep Physician Services Manager and supporting departments informed of potential credentialing and enrollment issues Update and maintain provider credentialing information database and electronic data files in accordance with internal policies and procedures while also maintaining confidentiality of provider information Actively participate in team meetings and process improvement initiatives to continuously improve work product and efficiency Develop, document, and maintain accurate work instructions for the desk, ensuring all procedures and information remain current Promote the purpose, values and foundations of Inspire Health Medical Group at all levels of the organization and to our customers Perform other related duties as assigned to support Physician Services operations Requirements High School Diploma or equivalent; Associate’s degree preferred Minimum two (2) years of credentialing experience in a medical setting #J-18808-Ljbffr