Credentialing Specialist II
Credentialing Specialist II
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Salary Not Disclosed
1 Vacancy
Job Description
Job Type Fulltime
Description $60000
We are currently seeking a Credentialling Specialist II to act as primary lead and subject matter expert overseeing all database systems workflows and processes related to provider credentialing and payer enrollment. In this role you will be responsible for ensuring optimal functionality accuracy and compliance across the credentialing database and enrollment processes for all service lines ensuring adherence to FQHC standards and regulatory requirements. Additionally you will act as the key expert on payer enrollment requirements guiding internal teams and stakeholders to ensure timely and accurate enrollment with Medicare Medicaid and private payers.
General job duties:
Credentialing Database & Workflow Oversight:
- Serve as the organizational lead responsible for managing and maintaining the credentialing database ensuring data integrity efficiency and compliance with federal state and payer regulations.
- Develop implement and refine credentialing workflows and processes to support operational efficiency and ensure consistency across all departments and service lines.
- Coordinate and monitor the credentialing process for all healthcare providers including licensed independent providers and clinical support staff.
- Verify and update licensure certifications education and qualifications ensuring primary source verification and compliance standards are met.
- Ensure timely initial and renewal credentialing including licensure certifications privileges and board approvals.
- Continuously monitor credentialed staff for any sanctions exclusions or disciplinary actions including NPDB OIG SAM and Ohio Medicaid Exclusion lists.
- Oversee all credentialing file maintenance and management within the database including initial and recredentialing documentation expiration dates and audit readiness.
- Facilitate internal and external audits ensuring that credentialing records are accurate and auditready at all times.
- Oversee single case agreements and credentialingrelated hospital privileges for specialized providers.
Subject Matter Expert in Payer Enrollment:
- Act as the subject matter expert (SME) for all payer enrollment processes across all service lines and departments.
- Lead the payer enrollment process including preparation submission and maintenance of enrollment applications and documentation for Medicare Medicaid private insurance and managed care organizations.
- Monitor payer enrollment statuses troubleshoot delays and implement solutions to ensure expedited processing.
- Maintain and update all payer contracts enrollment statuses fee schedules CAQH profiles and expiration/renewal timelines within the database.
- Collaborate with revenue cycle billing and finance teams to ensure accurate and timely provider enrollment information facilitating smooth reimbursement processes.
- Keep up to date with evolving payer enrollment requirements FQHC regulations and payerspecific policies communicating changes and ensuring ongoing compliance.
- Respond promptly to inquiries regarding credentialing and payer enrollment processes from both internal teams and external entities.
Compliance Leadership:
- Ensure credentialing and enrollment activities are fully compliant with FQHC guidelines HRSA CMS TJC CARF and other regulatory bodies.
- Collaborate with compliance risk management and quality teams to regularly audit credentialing and enrollment processes implement corrective actions and support continuous improvement efforts.
- Stay informed about federal state and payer regulations ensuring Third Street remains compliant with all credentialing and enrollment standards.
Communication & Collaboration:
- Serve as the lead point of contact for all credentialing and payer enrollment matters providing guidance and expertise to internal staff leadership and external stakeholders.
- Coordinate closely with human resources billing finance legal and clinical teams to align credentialing and enrollment efforts with broader organizational priorities.
- Maintain open communication channels with payers credentialing organizations and regulatory agencies to facilitate efficient processes and address issues promptly.
- Act as a positive role model fostering collaboration and knowledgesharing across departments.
Third Street is an equal opportunity employer. Our goal is to be a diverse workforce that is representative at all job levels of the communities and patients we serve. We do not discriminate on the basis of race color religion marital status age national origin ancestry physical or mental disability medical condition pregnancy genetic information gender sexual orientation gender identity or expression veteran status or any other status protected under federal state or local law. If you require reasonable accommodation in completing this application please direct your inquiries to or callext. 2201 for Human Resources.
What We Offer:
Attending to your needs today:
- Your ideas input and contributions are valued and recognized.
- Excellent clinical administrative and management support
- Forwardthinking collaborative transparent and inclusive company culture
- Employee Assistance Program
- Competitive Medical Dental and Vision plans
- Competitive compensation
- Paid Time Off
- Wellness Reimbursement Program
- Tuition assistance
Protecting your future:
- Medical dental and vision insurance
- 403(b) retirement plan
- Employerpaid life insurance
- Employerpaid longterm disability
Qualifications:
- Bachelors degree in healthcare administration or health information management
- Previous experience in credentialing and payor enrollment within a healthcare setting preferably FQHC required.
- Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) from NAMSS or the Certified Professional in Health Quality (CPHQ) from NAHQ
- Experience in credentialing software/database systems required.
About Us: Third Street is a patientcentered medical home driving change in the community. We adapt to the needs of those we serve while building services to fill gaps in care to invest in a healthier future for all. At Third Street we provide highquality care through the continual learning of our employees and by building a diverse team. We value our employees communicate our expectations and train our team on best practices.
Organizational Information:
- Established in 1994 Third Street Family Health Services is a regional notforprofit community health center providing medical dental OB/GYN pediatric community outreach and behavioral health services across eleven locations in Richland Marion Ashland and Crawford counties. Our mission is to deliver comprehensive health and wellness care accessible to all in the communities we serve. We believe that the health status of our community can be improved by providing accessible and affordable health care advocacy and community health initiatives.
- We provide patientcentered care and provide our services with respect integrity and accountability top of mind. For more information visit tsfhs or find them on Facebook or Twitter.
Mission:
To deliver comprehensive health and wellness care accessible to all in the communities we serve.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
