Credentialing Specialist
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Job Description
Credentialing Specialist supporting provider enrollment, CAQH profiles, medical licenses, and hospital privileging. Maintaining credentialing records and applications for U.S. Digestive Health.
Responsibilities:
- Support initiatives across the credentialing team
- Assist with provider enrollments
- Maintain CAQH profiles
- Obtain and review physicians’ medical licenses
- Help with hospital privileging
- Complete and process credentialing applications
- Collect provider credentials and update internal and external databases
- Review and streamline onboarding processes and workflows, using automation where appropriate
- Interact with management, physician office staff, and physicians to accomplish credentialing activities
- Maintain up-to-date provider data in credentialing databases and online systems
- Maintain accurate provider rosters for insurance companies
- Track CAQH completion and re-attestation dates
- Track expirables such as medical licenses, DEA, and CDS
- Notify administration, billing, and operations of provider effective dates
- Maintain confidentiality of provider information
- Complete initial hospital and reappointment applications
Requirements:
- 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
- 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
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