Credentialing Specialist
Credentialing Specialist
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
Job Overview:
We are seeking a detail-oriented and organized Credentialing Specialist to manage the full cycle of credentialing and payer enrollment for our behavioral health providers. This role ensures our clinicians are properly enrolled with payers remain compliant with credentialing standards and are accurately listed in all directories. You will also play a vital role in resolving billing issues tied to credentialing or enrollment delays.
Key Responsibilities:
- Oversee and manage the complete credentialing and re-credentialing process for new and existing providers across multiple payers.
- Prepare and submit accurate and timely applications for initial credentialing and recredentialing with insurance companies.
- Maintain and update provider records in credentialing systems (e.g. CAQH) including regular attestations and verifications.
- Monitor application status follow up with payers and provide timely updates to providers and leadership.
- Build and maintain working relationships with insurance plan representatives to troubleshoot and resolve credentialing or contracting issues.
- Track and manage renewals for all state licenses DEA certificates liability insurance and other required documents.
- Conduct regular audits to ensure accurate provider listings in health plan directories.
- Stay informed on changes in payer policies and credentialing requirements.
- Assist with departmental projects reporting and process improvement initiatives.
Required Qualifications:
Education:
- High school diploma or equivalent required.
- Associate degree or relevant certification (e.g. NAMSS CPCS) preferred. National Association Medical Staff Services Certified Provider Credentialing Specialist
Experience:
- Minimum of 2 years of experience in payer enrollment CAQH management or managed care credentialing.
- Experience in behavioral health credentialing is a plus.
Key Skills & Competencies:
- In-depth knowledge of the credentialing and enrollment process.
- Strong organizational and time management skills with the ability to manage multiple priorities.
- High attention to detail and accuracy.
- Proficient in Microsoft Office Suite (Word Excel Access) and internet-based research.
- Excellent written and verbal communication skills.
- Able to work independently and collaboratively in a fast-paced environment.
- Strong interpersonal skills and ability to maintain effective relationships with internal and external stakeholders.
Preferred Skills:
- Detail-Oriented: Thorough in work and careful with details.
- Team Player: Works cooperatively and respectfully with others.
- Dedicated: Demonstrates reliability and commitment to responsibilities.
- Functional Expert: Deep understanding of credentialing and enrollment best practices.
Why Join Us
- Mission-driven organization focused on quality behavioral health care.
- Collaborative and supportive work environment.
- Opportunities for professional development and growth.
- Comprehensive benefits package including medical dental vision and 401k
- PTO and paid holidays
EEO Statement:
It our policy to provide equal employment opportunity and treat all employees equally regardless of age race creed/religion color national origin immigration status or citizenship status sexual orientation military or veteran status sex/gender gender identity gender expression disability genetic information or genetic predisposition or carrier status marital status partnership status victim of domestic violence sexual or other reproductive health decisions or other characteristics protected by applicable law.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
