Credentialing Specialist

Position Overview :

We are seeking a highly organized and detail-oriented Credentialing Specialist to oversee and manage all aspects of credentialing and payer coordination for our Skilled Nursing Facilities (SNFs). This individual will be responsible for maintaining provider credentials, ensuring compliance with payer requirements, managing re-credentialing timelines, and working directly with insurance plans to negotiate and update rates and agreements.

Key Responsibilities :

Manage and maintain up-to-date credentialing files for all facilities and providers.

Ensure timely submission of initial and renewal credentialing applications with all contracted payers.

Monitor and track expiration dates for licenses, certifications, and other critical documentation.

Serve as the main point of contact between our organization and insurance companies for all credentialing and contracting matters.

Review and maintain participation status with insurance plans and government programs.

Coordinate and negotiate reimbursement rates and contract terms with payers to ensure competitive and sustainable agreements.

Ensure compliance with federal, state, and payer-specific credentialing and billing requirements.

Maintain accurate records and databases to track credentialing and payer contracts.

Collaborate with internal departments (billing, admissions, clinical leadership) to ensure alignment on credentialing and insurance participation matters.

Qualifications :

Proven experience in healthcare credentialing, preferably in a skilled nursing or long-term care setting.

Familiarity with commercial and government payers, including Medicare and Medicaid.

Strong understanding of credentialing regulations, compliance requirements, and payer contracting.

Excellent organizational skills with a high level of accuracy and attention to detail.

Strong communication and negotiation skills.

Proficient in Microsoft Office and credentialing software systems.