Senior Credentialing Specialist

The Senior Credentialing Specialist supports the accurate and timely credentialing and recredentialing of healthcare providers with insurance networks, clearinghouses, and other credentialing bodies.

Requirements

• Assist the Senior Credentialing Specialist in preparing, submitting, and tracking provider enrollment applications for insurance networks and credentialing organizations.
• Ensure the accuracy and completeness of provider credentialing documentation, including licenses, certifications, and insurance coverage.
• Monitor and update credentialing timelines, ensuring compliance with deadlines and payer requirements.
• Perform primary source verifications as directed, maintaining adherence to regulatory and organizational standards.
• Maintain organized credentialing records and ensure accurate data entry in credentialing software or databases.
• Assist in audits of credentialing files to verify compliance with HIPAA and other regulatory requirements.
• Act as a liaison between the Senior Credentialing Specialist, healthcare providers, and external entities to resolve credentialing-related issues.
• Follow up with providers, payers, and clearinghouses to gather required information or clarify discrepancies.
• Communicate updates on credentialing processes and progress to the Senior Credentialing Specialist and management.
• Provide support during high-volume credentialing periods, including managing overflow tasks as assigned by the Senior Credentialing Specialist.
• Prepare reports and summaries of credentialing activities for review by the Credentialing Manager or team.
• Assist in training new team members on credentialing processes and software.