Credentialing Specialist

Job Description

Job Description

We are looking for an experienced Credentialing Specialist to join our team on a short-term contract basis. The ideal candidate will play a vital role in ensuring healthcare providers are accurately credentialed and privileged with various insurance providers, including Medicaid and Medicare. This position may offer hybrid remote work flexibility, depending on the assignment details.

Responsibilities :

• Oversee the collection, verification, and organization of credentialing documentation for new and existing healthcare providers.
• Manage the processing, distribution, and tracking of credentialing applications and related documents to ensure compliance with industry standards.
• Develop and maintain efficient systems and procedures to streamline credentialing operations.
• Ensure all credentialing processes align with relevant regulations, policies, and accreditation standards.
• Create and update a comprehensive credentialing database to track provider information and documentation.
• Provide timely follow-up and resolve issues or discrepancies related to credentialing documentation.
• Handle administrative tasks associated with the credentialing process, including troubleshooting and resolving day-to-day challenges.
• Collaborate with providers and insurance entities to facilitate approvals and maintain smooth workflows.
• Monitor deadlines and maintain accurate records to ensure timely completion of credentialing and re-credentialing processes.
• Assist with implementing alert systems to track provider credentials and renewals.
• Proven experience in credentialing processes, including provider and physician credentialing.
• Familiarity with Medicaid and Medicare credentialing requirements.
• Strong organizational skills with exceptional attention to detail and follow-through.
• Proficiency in maintaining credentialing databases and tracking systems.
• Ability to manage multiple tasks and meet deadlines in a fast-paced environment.
• Excellent communication skills for collaborating with providers, insurance companies, and team members.
• Knowledge of healthcare regulations and standards related to credentialing.
• Experience with re-credentialing applications and administrative processes.