Credentialing Specialist
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Job Description
Credentialing Specialist supporting practitioner credentialing and recredentialing for a national outpatient physical and occupational therapy provider. Maintaining compliant provider records, verifications, and payer documentation.
Responsibilities:
- Support initial credentialing and recredentialing of practitioners within the Preferred Therapy Providers network.
- Collect and verify practitioner information.
- Conduct primary source verification.
- Maintain credentialing records, electronic files, and accurate practitioner data in the credentialing database.
- Access and manage practitioner information through CAQH and paper application systems.
- Provide administrative support for credentialing operations.
- Maintain practitioner licensing, credentialing, certification, and insurance records.
- Monitor license, certification, insurance, and continuing education requirements, including expiration and renewal dates.
- Communicate with internal stakeholders and external practitioners regarding application status, credentialing requirements, and outstanding documentation.
- Perform credentialing and recredentialing in accordance with federal and state regulations, payer requirements, accreditation standards, and company policies.
- Monitor files and outstanding requirements, escalating delays, deficiencies, or compliance concerns.
- Maintain confidentiality, integrity, and security of practitioner information.
- Crosstrain and support other functional areas as needed.
- Perform other projects and duties as assigned.
Requirements:
- High school diploma or equivalent experience.
- Strong attention to detail, self-motivation, and effective written and verbal communication skills.
- Demonstrated ability to establish and maintain positive working relationships with providers, leadership, staff, and external partners.
- Proficiency in Microsoft Office applications, including Word and Excel, Adobe Acrobat, and web-based systems.
- Proven ability to organize and prioritize work, manage multiple responsibilities, and meet deadlines in a fast-paced environment.
- Must reside in the United States.
- Previous experience with healthcare credentialing, provider enrollment, revenue cycle operations, or other healthcare administrative functions.
- Experience supporting healthcare organizations, including physical therapy, rehabilitation, or related clinical settings.
Benefits:
- Annual paid Charity Day to give back to a cause meaningful to you
- 100% employer paid medical health insurance premium option available
- Dental and Vision insurance
- 401(k) with company match
- Generous PTO and paid holidays
- Supportive team and leadership invested in your success
- Competitive compensation
- Comprehensive benefits
- Ongoing professional development
- Leadership development programs
- Ongoing education and professional growth opportunities
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